SBIRT Toolkit

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Brief: Initial screening is accomplished quickly, typically 5-10 minutes, and interventions are completed in significantly less time than traditional care.

Universal: Screening should be completed will all patients, clients, students, or other target populations as part of a standard intake process.

Targeted: The screening addresses one or more specific behaviors related to risky alcohol or drug use, or behavioral characteristic deemed to be problematic.

Adaptable: Services can occur in a variety of public health settings. Comprehensive: Includes a seamless transition between screening, brief intervention/treatment, and referral to treatment.

Effective: Strong research and/or experiential evidence supports the model’s effectiveness and demonstrates the approach as successful.

Effects of unhealthy and unsafe alcohol and drug use have far-reaching implications for the individual, family, workplace, community and the health care system.

Alcohol and drug use are serious and can create an increased risk for injury/trauma, criminal justice involvement, social problems, mental health conditions (e.g. anxiety, depression), and increased absenteeism and accidents in the workplace.

A growing body of evidence about SBIRT’s effectiveness – including cost-effectiveness – has demonstrated its positive outcomes.

The research shows that SBIRT is an effective way to reduce drinking and substance misuse problems and is used to reinforce positive behaviors.

By intervening early, SBIRT can save lives, money, and is consistent with overall support for patient wellness.

SBIRT improves outcomes for chronic diseases and can contribute to the wellness of patients. Often substance use is the missing link in improving overall health and impacting specific conditions. Screening has identified substance use as a contributing factor to more than 70 medical conditions. Serious negative health-related problems associated with long-term, excessive alcohol and substance use include cancers, strokes, nonfatal and fatal overdoses, diabetes, hypertension, hepatitis, mental illnesses and HIV. Late-stage intervention and substance misuse treatments are expensive, and by that point, the patient has often developed co-morbid health conditions that could have been avoided with earlier treatment.

Screening is a process of routine patient care using validated screening tools to identify the presence and level of risk associated with a patient’s substance use behaviors.

Screening does not provide a diagnosis of substance use or related disorders; however, it can help identify patients demonstrating risky behaviors, including those who would not otherwise disclose their behaviors or harmful outcomes they are experiencing.

Screening includes assessing for use of alcohol, illicit drugs, and tobacco/nicotine, as well as the presence of mental health
conditions (depression, anxiety, bipolar, PTSD, and suicide).

Brief Intervention is a collaborative conversation intended to reduce substance use and associated risky behaviors, and in some cases encourage the patient to accept a referral to treatment.

The brief intervention is focused on increasing the patient’s insight and awareness regarding substance use and his or her motivation toward behavioral change.

Brief interventions can be tailored for variance in population or setting.

Some patients may need more support to change their behaviors and use.

Brief treatment with a qualified clinician may be necessary to develop awareness, rebuild skills, and develop a support network that will assist in sustaining behavior change.

Brief treatment differs from brief interventions and other treatments. It is a structured counseling method that helps patients identify personal beliefs about substance use and how these beliefs influence their feelings and behaviors.

Referral to specialized treatment is provided to those identified as needing more extensive treatment than offered by the SBIRT program.

The effectiveness of the referral process to specialty care is a strong measure of SBIRT success and involves a proactive and collaborative effort between SBIRT providers and community treatment providers.

Developing and sustaining relationships with referral agencies is key to ensure a successful warm hand off and access to further assessment, diagnosis, and the most appropriate level of care.

When deciding to integrate SBIRT into your existing practice and workflow there are some crucial decisions that must be made:

• Screening: Who performs? Frequency? What tools? Protocol?
• Brief Intervention: Who performs? Format? Protocol?
• Referral: Who performs? Where to? Confidentiality? Protocol?
• Billing: Will you bill? How to Document? Are the systems in place? Protocol?
• Performance Monitoring and Evaluation: Who does this? How is it reported? Protocol?
• Informing all staff: How will staff at the site be informed of the new initiative? On an ongoing basis? Who will champion the initiative?
• Training: Who will train staff? Who will receive training? Ongoing supervision and training?

It is important to conduct an assessment specific to the implementation site to better understand how the SBIRT components need to be tailored.

The assessment will help determine what barriers most need to be addressed during implementation via training, resource allocation, and model adaptation.