SBIRT: Screening, Brief Intervention, and Referral to Treatment
Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based practice used to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and illicit drugs. The SBIRT model was incited by an Institute of Medicine recommendation that called for community-based screening for health risk behaviors, including substance use.
SBIRT CONSISTS OF THREE MAJOR COMPONENTS:
Screening — a healthcare professional assesses a patient for risky substance use behaviors using standardized screening tools. Screening can occur in any healthcare setting
Brief Intervention — a healthcare professional engages a patient showing risky substance use behaviors in a short conversation, providing feedback and advice
Referral to Treatment — a healthcare professional provides a referral to brief therapy or additional treatment to patients who screen in need of additional services
In order to propagate SBIRT use, CIHS compiled an array of information and tools to guide implementation of SBIRT in any community health setting. The resources are designed to help answer the most common questions related to SBIRT, such as:
Su bstance (Other Than Tobacco) Abuse Structured Assessment and Brief Intervention (SBIRT) Services, Fact Sheet, created by CMS, provides education on substance abuse structured assessment and brief intervention (SBIRT). It includes an early intervention approach that targets individuals with nondependent substance use to provide effective strategies for intervention prior to the need for more extensive or specialized treatment.
Why SBIRT? is a primer developed by the Colorado SBIRT initiative to acquaint readers with SBIRT.
The BIG (Brief Intervention Group) Initiative SBIRT Education is a national organization of individuals and organizations founded by Drs. Eric Goplerud and Tracy McPherson that joined together to promote routine screening for hazardous alcohol use and brief solution-focused counseling in every Employee Assistance Program and workplace health and wellness program. The site contains a comprehensive training on SBIRT, as well as a webinar series cover SBIRT implementation in various settings and populations.
The Substance Use in Adults and Adolescents: Screening, Brief Intervention and Referral to Treatment (SBIRT) free online SBIRT course through Medscape, aims to address the basic principles of SBIRT as well as coding and reimbursement for the implementation of SBIRT in practice.
** A free membership to Medscape is required to view the training.
The SBIRT App, developed at Baylor College of Medicine to support the use of SBIRT by physicians, other health workers, and mental health professionals is free to download. The app provides evidence-based questions to screen for alcohol, drugs and tobacco use. If warranted, a screening tool is provided to further evaluate the specific substance use. The app also provides steps to complete a brief intervention and/or referral to treatment for the patient based on motivational interviewing.
NAADAC, the Association for Addiction Professionals, has partnered with National SBIRT ATTC, NORC at the University of Chicago, The BIG Initiative, and SAMHSA to deliver a FREE 8-part SBIRT webinar series. All webinars are worth 1.5 CEs. Webinar topics include: implementing SBIRT in health centers; understanding the Affordable Care Act and SBIRT; and the use of SBIRT with specific populations, including older adults, veterans and active duty personnel, and the LGBTQ population. Click here for the full schedule and additional information.
The SBIRT reimbursement map is an interactive tool designed to help determine whether billing codes are listed on a state’s fee schedule, and, if listed, whether or not they are open for reimbursement (i.e. a billing amount has been assigned to the codes).
The Annals of Internal Medicine journal article Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse: U.S. Preventive Services Task Force Recommendation Statement provides a good overview of ways to improve long-term health outcomes, the harms of screening and behavioral health counseling interventions, and influences from the health care system that promote or detract the effectiveness of screening and counseling interventions for alcohol misuse.
Care for hospitalized patients with unhealthy alcohol use: A Narrative Review
This review is targeted to hospital-based clinicians and administrators who are responsible for generally ensuring the provision of high quality care to patients presenting with a myriad of conditions, one of which is unhealthy alcohol use. The review summarizes the major issues involved in caring for patients with unhealthy alcohol use in the general hospital setting, including prevalence, detection, assessment of severity, reduction in drinking with brief intervention,common acute management scenarios for heavy drinkers, and discharge planning.
TAP 33: Systems-Level Implementation of SBIRT
SAMHSA's newest Technical Assistance Publication (TAP) is a compilation of research and experience from over a decade of federally-funded work on SBIRT. It includes specific implementation models, details about reimbursement and sustainability, and case studies across the nation.
SBIRT in a Radically and Rapidly Changing Environment is a powerpoint that highlights SBIRT in the context of healthcare reform. The webinar which was conducted by the Altarum Institute for SAMHSA can be found below.
The Addiction Technology Transfer Center (ATTC) created an guide: SBIRT: A Resource Toolkit for Behavioral Health Providers to Begin the Conversation with Federally-Qualified Healthcare Centers. This resource provides behavioral health providers with information to engage their local FQHC and community health centers in conversations around implementing SBIRT.
Frequently Asked Questions by Healthcare Providers developed by the Colorado Clinical Guidelines Collaborative provides answers to questions commonly asked by providers when beginning to implement SBIRT.
Since 2003, SAMHSA has funded 17 Medical Residency Cooperative Agreements, 15 State Cooperative Agreements, and 12 Targeted Capacity Expansion Campus Screening and Brief Intervention (SBI) Grants. Learn more about SAMHSA’s SBIRT grantees.
A presentation for HRSA grantees discusses SBIRT implementation in Ryan White settings.
Why SBIRT? is a primer developed by the Colorado SBIRT initiative to acquaint readers with SBIRT.
NIAAA’s Helping Patients Who Drink Too Much: A Clinician’s Guide focuses on implementing alcohol screening and intervention in any healthcare setting.
A SAMHSA Treatment Improvement Protocol (TIP), TIP 24: A Guide to SA Services for Primary Care Clinicians provides guidelines to primary care clinicians for caring for patients with alcohol and drug abuse problems. TIP 24 discusses screening, assessment, brief intervention, medication-assisted treatment, and legal issues of patient confidentiality.
The American Public Health Association manual, Alcohol Screening and Brief Intervention: A guide for public health practitioners, provides public health professionals such as health educators and community health workers with the information, skills, and tools needed to conduct screening and brief intervention to help at-risk drinkers limit or stop drinking.
SAMHSA’s TIP 42: Substance Abuse Treatment for Persons With Co-Occurring Disorders provides substance abuse providers with updated information on co-occurring substance use and mental disorders and advances in treatment for these individuals. TIP 42 discusses terminology, assessment, and treatment strategies and models.
The “Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse” booklet announces that effective with dates of service on and after October 14, 2011, the Centers for Medicare & Medicaid Services (CMS) will cover annual alcohol screening, and for those that screen positive, up to 4, brief, face-to-face behavioral counseling interventions annually for Medicare beneficiaries, including pregnant women.
Reducing Patient At Risk Drinking developed by the Emergency Nurses Association guides nurses and other healthcare professionals through implementation of SBIRT in emergency room settings.
The Institute for Research and Education in the Addictions developed SBIRT Screening, Brief Intervention and Referral to Treatment , which provides an array of useful information for emergency departments.
Screening and Brief Interventions (SBI) for Unhealthy Alcohol Use: A Step-by-Step Implementation Guide The CDC’s Screening and Brief Interventions for Unhealthy Alcohol Use: A Step-by-Step Implementation Guide for Trauma Centers helps Level I and II trauma centers plan and implement the American College of Surgeon’s Committee on Trauma’s alcohol-screening and brief intervention requirements.
Youth and Young Adults
Alcohol Screening and Brief Intervention for Youth: A PRACTITIONER’S GUIDE from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) introduces a simple, quick, empirically derived tool for identifying youth at risk for alcohol-related problems. If your organization manages the health and well-being of children and adolescents ages 9–18 years, this Guide is for you. It has been produced in collaboration with the American Academy of Pediatrics, clinical researchers, and health practitioners.
Screening and Brief Intervention Tool Kit for College and University Campuses was developed for the National Highway and Traffic and Safety Administration, this toolkit is designed to assist college and universities implement programs forconducting screening and brief intervention
Implementing Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Clinical Settings Webinar
CIHS hosted the Implementing SBIRT in Community Health and Behavioral Health Centers webinar to provide a through overview of SBIRT.
SBIRT and Tobacco Training Module is a webinar developed by HealthTeamWorks for the Colorado SBIRT project that provides practical information for providers seeking to implement SBIRT and tobacco screening into routine practice. In addition to overviews of tobacco screenings and SBIRT, the 1-hour webinar includes information on financing, brief interventions, and referrals to treatment.