SBIRT IN VARIOUS SETTINGS: DIFFERENCES & COMMON THREADS Tracy - PDF document

5/4/17 Webinar Moderator SBIRT IN VARIOUS SETTINGS: DIFFERENCES & COMMON THREADS Tracy McPherson, PhD Senior Research Scientist Public Health Department PRESENTED BY: NORC at the University of Chicago Pam Pietruszewski, Integrated Health Consultant 4350 East West Highway 8th Floor, National Council for Behavioral Health Bethesda, MD 20814 esap1234@gmail.com May 4, 2017 Produced in Partnership… 2017 SBIRT Webinar Series ¨ 1/19/17 - Strategies for Incorporating Universal Education about Healthy Relationships into Clinical Practice to Reduce Substance Use and Intimate Partner Violence ¨ 2/16/17 - Using SBIRT when Intimate Partner Violence has been Disclosed ¨ 3/2/17 - WINGS: An Evidence-based SBIRT Intervention for Addressing Partner Violence Among Young Women Who Use Drugs or Alcohol ¨ 3/16/17 - When One Size Does Not Fit All: Addressing Issues Throughout an SBIRT Project Life Cycle ¨ 4/6/17 - Promoting SBIRT in an Interprofessional Setting with Vulnerable Populations ¨ 5/4/17 - SBIRT in Various Settings: Differences & Common Threads www.sbirteducation.com ¨ 6/15/17 - Using SBIRT for Problem Gambling in the Military Download this flyer from our hospitalsbirt.webs.com/webinars.htm website! Access Materials Ask Questions ¨ PowerPoint Slides Ask questions ¨ Materials and through the Resources “Questions” Pane ¨ Recording ¨ Certificate of Will be Completion answered live at the end http://hospitalsbirt.webs.com/various-settings 1

5/4/17 Technical Facilitator Webinar Presenter Pam Pietruszewski, MA Misti Storie, MS, NCC Integrated Health Consultant Technical Consultant National Council for Behavioral Health misti.storie@gmail.com pamp@thenationalcouncil.org www.mististorie.com “ Eighty percent of life is showing up. ” The National Council for Behavioral Health is the Woody Allen unifying voice of America’s mental health and addictions treatment organizations. Together with 2,900 member organizations, serving 10 million adults, children and families living with mental illnesses and addictions, the National Council is committed to all Americans having access to comprehensive, high-quality care that affords every opportunity for recovery. Join us at National Council Hill Day October 2 & 3, 2017 www.TheNationalCouncil.org Register here. Today’s webinar SBIRT in Various Settings ¨ Explore SBIRT components in the context of differing geographies and how community partnerships can share resources and solutions. ¨ Identify strengths and opportunities among your Differences & Common Threads workforce to optimize conversations about motivation and behavior change. ¨ Determine workflow efficiencies that leverage opportunities to connect physical health, mental health and substance use. 2

5/4/17 SBIRT in Medical Settings “How are we impacted by substance use?” #2 Local data ¨ Culture: Fast paced, appts every 15 min, “patient” ¨ Champions: PCP , Clinic Manager #3 Shared problem, shared solutions ¨ SU connection: Medical condition(s), treatment effectiveness • Schools § Primary care ¨ Meaningful data: Improvement in related medical • Law enforcement § Behavioral health conditions, ED use, accident/injury reduction • Social services § Hospitals • Media § Public health • Chamber of commerce Partners in Integrated Care Dissemination & Implementation Project, funded by AHRQ: http://www.prhi.org/initiatives/pic Facilitating Change for Excellence in SBIRT, funded by the Conrad N. Hilton foundation: https://www.thenationalcouncil.org/press-releases/conrad-n-hilton-foundation-awards-national-council- 2m-screening-brief-intervention-referral-treatment-sbirt-learning-initiative/ Achieving SBIRT Practice Transformation, SAMHSA contract # HHSP233201600258A Highest Ranked Preventive Services Consider this…. Based on Clinically Preventable Burden + Cost Effectiveness Flu shot Childhood immunization series Blood pressure Tobacco use brief prevention counseling - youth #1 Tobacco use screening & brief counseling - adults Early stage cancer Alcohol SBI – adults Aspirin prevention for adults at higher risk for CVD #2 Cervical cancer screening Colorectal cancer screening Chlamydia & gonorrhea screening Cholesterol screening #3 Hypertension (BP) screening Maciosek et al, Annals of Family Medicine 2017 PC Workforce & Workflow SBIRT in the Courts Brief screening on paper or ¨ Culture: Judicial process can be lengthy, mandated, Considerations tablet given at front desk check in “offender” • “Everyone working at ¨ Champions: DOT, judge, sheriff, public health Rooming nurse reviews results and the top of their license” ¨ SU connection: Arrests, incarceration, fees, penalties administers full screen if score • Messaging for front ¨ Meaningful data: Recidivism warrants desk PCP education & collaborative • Treatment referral with conversation with patient coordination and follow up Moving away from One-Size-Fits-All Handling of DWI offenders. Judge Warm handoff to BHC/care Shaun R. Floerke, Foundation for Advancing Alcohol Responsibility manager/health educator if score https://responsibility.org warrants 3

5/4/17 Judicial Workforce & Workflow SBIRT in Mental Health Settings Court date Court date ¨ Culture: Assumption that MH/SU expertise is the same, brief is hard, “client” or “consumer” Considerations Report to courtroom Report to probation ¨ Champions: Executive director, program & clinical for arraignment for SBIRT directors • Public health, SUD ¨ SU connection: Co-occurring capabilities, referral treatment Report to courtroom Judge introduces relationship for arraignment SBIRT program • Teachable moment ¨ Meaningful data: Improvement in related mental health conditions, employment, stable housing, Judge reinforces Interventionist • Paperwork, social/relationships SBIRT program conducts SBIRT streamlining, timing and process flow Probation follow up Interventionist phone call at 3 follow up phone Reducing Adolescent Substance Abuse Initiative, funded by the Conrad N. months call at 3 months Hilton foundation: https://www.hiltonfoundation.org/learning/substance-use- prevention-initiative-2016-evaluation-report MH Workforce & Workflow Why Screen in Mental Health Settings? • People with mental health issues New Intake: Primary Screening and other Screening are disproportionately affected by clinician screens during paperwork is emailed administered by substance use issues. the first 30 day prior to first visit intake coordinator assessment period • Benefits to individual health Counselor reviews BI done by therapist Rescreen: Primary • Reduction in health-related and with client at first visit societal costs clinician adds 90 day reminder in Rescreen done by If RT, counselor monitors • Mental health practitioners are their email calendar intake coordinator well-placed for screening and progress with SUD for a week prior to if no longer counseling the 90 days program and checks in receiving therapy regularly as part of services therapy MH Considerations Adolescents ¨ Confidentiality We saw a cognitive shift in staff ¨ Often already thinking about and buying into ¨ Rapport & Engagement long intake consistently conducting screening process School based services: and brief interventions for ¨ How to integrate substance misuse. Their initial ¨ More opportunity for follow up BI with therapy doubts about their capability and ¨ School-based clinic vs school system ¨ “Harm competence in addressing ¨ Recent legislation in MA, NJ in process reduction” substance use has significantly resonates improved. https://malegislature.gov/Laws/SessionLaws/Acts/2016/Chapter52 http://www.masbirt.org/schools http://www.njleg.state.nj.us/2016/Bills/S3000/2967_I1.PDF 4

5/4/17 SBIRT Resources for Other Settings In Schools HIV/AIDS Treatment Centers AIDS Education & Training Center Program ¨ Build into existing services rather than bringing it in as https://aidsetc.org/resource/short-and-simple-substance-use- something new screening-and-brief-intervention-hiv-care-settings ¨ Traditional model - kids only identified if they get into trouble ¨ SBIRT model - systematic screening, more potential to detect Emergency Departments unmet needs Institute for Research, Education and Training in Addictions (IRETA) http://www.integration.samhsa.gov/clinical-practice/sbirt Schools are major source of behavioral health care for many Trauma Centers students – 21x more likely to visit a school-based health center CDC & National Center for Injury Prevention and Control for behavioral health than a community-based health center http://www.integration.samhsa.gov/clinical-practice/CDC- NIDA 2016, Weinstein 2006 Screening_and_Brief_Interventions.pdf Common Thread: Data to Inform Champions & Supervisors Awesome, we increased our SBIRT enrollment! What organizational factors contributed? Which staff were part of this increase? Connecting data to actions What is working? Hey we’ve had 7 clients with documented improvement! What can we learn from the staff who worked with them? Great! No one received only an RT! Where can we promote Who were the clients that didn’t receive a BI or RT when these results to demonstrate it was indicated? What were the circumstances? our value? 5