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					SBIRT   Screening, Brief Intervention and Referral to Treatment
SBIRT   Screening, Brief Intervention and Referral to Treatment




          •What is SBIRT?

          •Why implement SBIRT?

          •Where do we go from here?

          •Resources
SBIRT   Screening, Brief Intervention and Referral to Treatment




         •SBIRT is the acronym for Screening, Brief Intervention and
         Referral to Treatment

         •SBIRT is designed to identify, intervene and treat people
         with substance abuse problems
SBIRT   Screening, Brief Intervention and Referral to Treatment




         •SBIRT works

         •SBIRT saves money
SBIRT   Screening, Brief Intervention and Referral to Treatment




          SBIRT reduces injuries and ED re-admissions
          SBIRT reduces substance misuse and abuse
          •Brief interventions as short as 30 minutes significantly
          reduced problem drinking. Also, a 47 percent reduction in
          injuries requiring ED or trauma center re-admission at
          three years.
          Gentilello, et al., Alcohol Interventions in a Trauma Center as a Means of Reducing
          the Risk of Injury Recurrence, Annals of Surgery, 1999


          •Collaborative study by NIAAA and SAMHSA indicated that
          speaking to ED patients about their alcohol consumption
          reduces hazardous drinking in those patients.
          Alcohol & Drug Abuse Weekly, January 2008
SBIRT   Screening, Brief Intervention and Referral to Treatment




          •Meta-analysis of 21 randomized trials in primary
          care found that SBIRT recipients reduced alcohol
          intake by three drinks per week. Results consistent
          across all trials.
          Kaner, et al., Brief Intervention in Primary Care for Alcohol Misuse, International Journal
          of Epidemiology, 2007
SBIRT   Screening, Brief Intervention and Referral to Treatment




         •Each $1 spent on screening and brief intervention saves
         almost $4 in other health care-related costs.
         Gentilello, et al., Alcohol Interventions for Trauma Patients Treated in EDs and
         Hospitals: A Cost-Benefit Analysis, Annals of Surgery, 2005

         •In January 2005, Alcohol & Drug Abuse Weekly estimated
         that emergency rooms and trauma centers could save up
         to $2 billion by offering brief substance abuse interventions
         to injured patients.
SBIRT   Screening, Brief Intervention and Referral to Treatment




          •Obtaining funding
          •Overcoming staff resistance
          •Effective SBIRT training
          •Navigating the insurance rapids
          •Picking the right assessment tool
SBIRT   Screening, Brief Intervention and Referral to Treatment




        There are a number of state and national programs offering funding for
        SBIRT studies:
        •Project InSight – Austin, Texas –
         www.insightforhealth.com

        •SAMHSA funding of SBIRT initiatives –
        http://sbirt.samhsa.gov/csat_awards/funding_opps.htm

        •National Institute on Alcohol Abuse and Alcoholism – Funding
        Opportunities
        www.niaaa.nih.gov/researchinformation/extramuralresearch/#funding
SBIRT   Screening, Brief Intervention and Referral to Treatment




        •SBI Toolkit for Healthcare –
        www.ensuringsolutions.org/resources/resources_list.htm?cat_id=2005

        •NIAAA Helping Patients Who Drink Too Much: A Clinician’s Guide –
        http://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide20
        05/clinicians_guide.htm

        •Emergency Nurses Association SBIRT Toolkit –
        http://www.ena.org/ipinstitute/SBIRT/ToolKit/Pages/toolkit.aspx
SBIRT   Screening, Brief Intervention and Referral to Treatment




          •SAMHSA –
          http://sbirt.samhsa.gov/tools_resources/curriculum.htm

          •Boston University –
          http://www.bu.edu/act/

          •InSight Provider Training –
          http://www.insightforhealth.com/provider.html
SBIRT   Screening, Brief Intervention and Referral to Treatment




          •Experienced trainers in Texas –
              •Carrie L. Dodrill, Ph.D
                   Veterans Affairs Medical Center
                   Houston, TX
                   Voice: 713-791-1414 x 6490
              •Mary Marden Velasquez, Ph.D
                   The University of Texas at Austin School of Social Work
                   Austin, TX
                   Phone: (512) 471-7019
              •Kirk von Sternberg, Ph.D
                   The University of Texas at Austin School of Social Work
                   Austin, TX
                   (512) 232-0633
                                                                             12
SBIRT   Screening, Brief Intervention and Referral to Treatment




         •As of April 2004, 38 states (including Texas) still had Uniform
         Accident and Sickness Policy Provision (UPPL) laws.
         UPPL repeal successful in several states, American College of Surgeons Cross Country, 2007


         •UPPL laws allow insurers to deny coverage when injury is
         alcohol- or drug-related.

         •Key informants for our study in Harris County did not cite UPPL
         as a barrier to treating patients found to be under the influence.
SBIRT   Screening, Brief Intervention and Referral to Treatment




         •A 2008 survey shows that 58 percent of U.S. health plans pay
         for screening and brief intervention, and that the federal
         government covers 5.8 million of its workers.
         Feds cover screening, brief intervention, Nation’s Health, 2008


         •With its efficacy proven, current procedural terminology (CPT)
         codes for SBIRT have been created:
                  -CPT 99408 for 15-30 minutes SBI
                  -CPT 99409 for > 30 minutes SBI
         American Medical Association, CPT 2008, Professional Edition, 2008
SBIRT   Screening, Brief Intervention and Referral to Treatment




         •Centers for Medicare and Medicaid Services (CMS) also have
         codes:
                  -Medicare
                          G0396 SBI >15 minutes
                          G0397 SBI > 30 minutes
                  -Medicaid
                          H0049 Screening
                          H0050 Brief Intervention
         American Medical Association, HCPCS 2008: Medicare’s National Level II Codes, 2008
SBIRT   Screening, Brief Intervention and Referral to Treatment




         •A SAMHSA guide reviews five major screening tools: AUDIT,
         CAGE, CRAFFT, BAC, and the binge drinking question.
         Alcohol Screening and Brief Intervention for Trauma Patients: Committee on Trauma
         Quick Guide, Alcoholism & Drug Abuse Weekly, May 2007

         •CAGE and AUDIT have emerged as most commonly used
         screening tools in emergency departments.
         Vaca & Winn, The Basics of Alcohol Screening, Brief Intervention and Referral to
         Treatment in the Emergency Department, Western Journal of Emergency Medicine,
         2007
SBIRT   Screening, Brief Intervention and Referral to Treatment




         •Funding:
                 -National Institute on Drug Abuse
                  www.nida.nih.gov/researchers.html

                 -Texas Department of State Health Services
                  http://www.dshs.state.tx.us/fic/default.shtm

                 -Project Mainstream
                 www.projectmainstream.net/projectmainstream.asp?cid=
                 82
SBIRT   Screening, Brief Intervention and Referral to Treatment




          •Training:
                   -Community Health Association of Mountain and Plain
                   States
                   http://www.champsonline.org/events/Distance_Libra
                   ry.asp#Vol15-18

                  -Society for Academic Emergency Medicine
                  http://www.saem.org/saemdnn/Home/Communities/
                  InterestGroups/PublicHealth/tabid/136/Default.aspx
SBIRT   Screening, Brief Intervention and Referral to Treatment




         •Research Into Action has prepared an all-inclusive resource
         guide.

         •You can start setting up your SBIRT program TODAY.




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SBIRT     Screening, Brief Intervention and Referral to Treatment




                 This program was produced and distributed by
            Research Into Action – A Knowledge Translation Initiative
                The University of Texas School of Public Health
                           Institute for Health Policy

         For more information about Research Into Action and the subject
        of knowledge translation, visit our Web site, www.ktexchange.org,
                or contact us at Researchintoaction@uth.tmc.edu

				
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