July 29, 2015 | Tags: Blog | Tags: Rural , Eastern Oregon , PCPCI Collaborative , SBIRT , Screening , Interview
Screening, Brief Intervention, and Referral to Treatment – better known as SBIRT - is a screening process that is a comprehensive, integrated, public health approach to the delivery of early intervention and treatment services for persons with substance use disorders, as well as those who are at risk of developing these disorders. SBIRT is used in primary care clinics, hospital emergency rooms, trauma centers, and other community settings that provide opportunities for early intervention with at-risk substance users before more severe consequences occur.
The different stages of the acronym focus on different parts of comprehensive treatment and education. Screening quickly assesses the severity of substance use and identifies the appropriate level of treatment. Brief intervention focuses on increasing insight and awareness regarding substance use and motivation toward behavioral change. Referral to treatment provides those identified as needing more extensive treatment with access to specialty care.
To learn more about SBIRT in practice, we connected with Stacie Rothwell and Lynda Haakenson of Harney District Hospital Family Care, a Patient-Centered Primary Care Home based in Burns, OR that achieved a high SBIRT screening rate in an analysis of claims data from 2013 - 2014. We discussed what HDH Family Care does to increase SBIRT screening rates, and why it is important to them.
In 2013 our clinic participated in a Patient-Centered Primary Care Home (PCPCH) Learning Collaborative through the Institute and led by the Oregon Rural Practice-based Research Network (ORPRN). We had a strong desire to become a Primary Care Medical Home and knew that implementing SBIRT screening was a part of that process.
First we had to get our providers educated on the SBIRT and get their buy-in. Dr. Johnston was our clinician leader participating in the learning collaborative and he played a huge role in getting all of the providers on board with the importance of the SBIRT screening. Next we had a clinic-wide staff meeting, during which we explained SBIRT’s importance, and expressed our goal of wanting to screen all adult patients at least once a year. From this meeting, we were able to implement a process for the SBIRT screening from start to finish. Because we took the time to plan for the entire cycle through a PDSA with all staff involved (front, back office and providers) ahead of time, everyone was on the same page and knew how it would work, and then it was easier to assess how we were doing and make any needed adjustments.
Our process begins before the patient is even at the clinic. We scrub our schedules the day before the patient’s appointment and determine what, if any paperwork is needed, including if they are due for an SBIRT. If the patient is new to our practice, or if they have not been screened in the past 12 months, a blank SBIRT folder is attached to their registration paperwork. Upon check in, they are given the SBIRT in a red folder and asked to complete it and keep that folder to give to the MA who check s them in. Upon check in, the MA scores the SBIRT, obtains additional screening tools if indicated and provides those scores and results to the provider. The red folder is key to us, the SBIRT is the only thing in our clinic that we use a red folder for so it is easily identifiable to all staff. In addition, we do not screen patients if they are coming in to see our on call provider as usually there is not enough time to address the SBIRT and generally the patient is acute and not feeling well.
Several challenges that we have faced since implementing this process have been easy to work though. Initially some patients were upset that this is billable service and they did not request the screen. Now, if a concern is raised, we give them the option to decline the SBIRT and document that in their chart. They are still asked to complete is annually, in case they change their mind. It has also been beneficial for our providers to explain the importance of the screening tool to the patients, and as a result, some have ended up completing them after initially declining the SBIRT. Probably the most difficult part of implementing our system was that the first few months were front loaded with nearly all patients needing to be screened. After about 2-3 months, this started to decline and it got much easier.
The takeaway for SBIRT for us has been that every once and a while it is a really good opportunity to really help someone – have a good conversation and get the patient thinking about their habits and lifestyle moving forward; possibly get them to change some things they didn’t even see as potential problems before, and that makes a difference. Every now and then the positive screenings turn out to be really helpful for the patients, which is very rewarding.
The Institute website links to a variety of resources on SBIRT, including recorded webinars (listed below) and essential training and patient education resources.
- Depression Screening & SBIRT for Adolescents: Practical Considerations for Implementing the CCO Incentive Metrics
- SBIRT: Behavioral Health Screenings and Patient-Centered Care
Stacie Rothwell is the Clinic Manager and Lynda Haakenson is the Office Manager for Harney District Hospital Family Care (HDH Family Care). Harney District Hospital is a Teir 3 Medical Home located in Burns, OR that serves small and rural ranching communities spread over 10,000 square miles. The Harney District Hospital also particpated in the Patient-Centered Primary Care Home (PCPCH) Learning Collaoborative through the Institute.