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A Digital Tool to Promote Alcohol and Drug Use Screening, Brief Intervention, and Referral to Treatment Skill Translation: A Mobile App Development and Randomized Controlled Trial Protocol.

Thu, 04/20/2017 - 10:51am
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A Digital Tool to Promote Alcohol and Drug Use Screening, Brief Intervention, and Referral to Treatment Skill Translation: A Mobile App Development and Randomized Controlled Trial Protocol.

JMIR Res Protoc. 2017 Apr 18;6(4):e55

Authors: Satre DD, Ly K, Wamsley M, Curtis A, Satterfield J

Abstract
BACKGROUND: Translation of knowledge and skills from classroom settings to clinical practice is a major challenge in healthcare training, especially for behavioral interventions. For example, screening, brief intervention, and referral to treatment (SBIRT) is a highly-promoted approach to identifying and treating individuals at risk for alcohol or drug problems, yet effective, routine use of SBIRT has lagged.
OBJECTIVE: The objective of this paper is to describe the development, pilot testing, and trial protocol of a mobile app based on the theory of planned behavior (TPB) to promote SBIRT skill translation and application.
METHODS: Intended for use after classroom training occurs, the mobile app has three primary functions designed to increase behavioral intent to deliver SBIRT: (1) review skills (ie, address knowledge and beliefs about SBIRT), (2) apply skills with patients (ie, build confidence and perceived behavioral control), and (3) report performance data (ie, increase accountability and social norms and/or influence). The app includes depression and anxiety screening tools due to high comorbidity with substance use. A randomized controlled trial (RCT) is in progress among health and social service learners (N=200) recruited from 3 universities and 6 different training programs in nursing, social work, internal medicine, psychiatry, and psychology. Participants are randomized to SBIRT classroom instruction alone or classroom instruction plus app access prior to beginning their field placement rotations. TPB-based data are collected via Qualtrics or via the mobile app pre-post and SBIRT utilization, weekly for 10 weeks. Key outcomes include the frequency of and self-reported confidence in delivery of SBIRT.
RESULTS: Beta testing with advanced practice nursing students (N=22) indicated that the app and its associated assessment tools were acceptable and useful. The system usability scale (SUS) mean was 65.8 (n=19), which indicated that the SBIRT app was acceptable but could benefit from improvement. Indeed, modifications were implemented prior to starting the trial. Enrollment of trial participants began in September 2016. Results are expected by December 2017.
CONCLUSIONS: This report describes the process of TPB-based app development and testing, and the protocol for a RCT to determine the effectiveness of the app in enhancing skill translation. If effective, this approach could improve SBIRT implementation, fidelity, and clinical outcomes.

PMID: 28420604 [PubMed - in process]

Problematic alcohol and other substance use among patients presenting to emergency services in South Africa: Who is ready for change?

Thu, 04/13/2017 - 10:51am
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Problematic alcohol and other substance use among patients presenting to emergency services in South Africa: Who is ready for change?

S Afr Med J. 2017 Mar 29;107(4):352-353

Authors: Sorsdahl K, Stein DJ, Naledi T, Breuer E, Myers B

Abstract
BACKGROUND: Studies that identify factors associated with intervention uptake are urgently needed in poorly resourced healthcare systems. This is important, as knowing who is likely to engage may lead to intervention targeting, which is an efficient use of scarce health resources.
OBJECTIVE: To identify patient characteristics that predict the acceptance of a brief intervention for substance use delivered in emergency departments (EDs).
METHODS: Patients presenting to three EDs were screened for substance use using the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). All patients identified as at risk for substance use problems were offered a brief psychotherapy intervention focused on substance user education. Data were collected on patients' age, sex, presenting condition (injury/no injury), type of substance used, and severity of substance use. Logistic regression analysis was used to identify variables that predicted acceptance of the offer of a brief intervention.
RESULTS: Being between the ages of 25 and 39 years increased the likelihood of accepting an offer of help compared with 18 - 24-year-olds. Polysubstance users were less likely to accept an offer of help than patients with problematic alcohol use only, while patients with higher ASSIST scores were more likely to accept an offer of help than those with lower scores.
CONCLUSIONS: Findings suggest that more work is needed to understand the mechanisms underlying treatment acceptance. Brief interventions delivered in ED services in countries such as South Africa should target alcohol users with higher ASSIST scores in order to ensure the efficient use of scarce health resources.

PMID: 28395690 [PubMed - in process]

A statewide screening, brief intervention, and referral to treatment (SBIRT) curriculum for medical residents: Differential implementation strategies in heterogeneous medical residency programs.

Mon, 03/27/2017 - 11:44am
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A statewide screening, brief intervention, and referral to treatment (SBIRT) curriculum for medical residents: Differential implementation strategies in heterogeneous medical residency programs.

Subst Abus. 2017 Feb 08;:1-7

Authors: Pringle JL, Kearney SM, Rickard-Aasen S, Campopiano MM, Gordon AJ

Abstract
BACKGROUND: Many screening, brief intervention, and referral to treatment (SBIRT) training curricula have been implemented within graduate medical residency training programs, with varying degrees of success. The authors examined the implementation of a uniform, but adaptable, statewide SBIRT curriculum in 7 diverse residency training programs and whether it could improve resident knowledge, skills, and attitudes regarding SBIRT and unhealthy alcohol and other drug (AOD) use.
METHODS: The authors assessed the implementation of the Pennsylvania SBIRT Medical and Residency Training (SMaRT) curriculum at 7 residency sites training a variety of disciplines. Faculty could use a variety of training modalities, including (1) Web-based self-directed modules; (2) didactic lectures; (3) small-group sessions; and/or (4) skill-transfer interactions with standardized or real patients in preceptor-led encounters. Acquisition of knowledge, skills, and attitudes regarding SBIRT and unhealthy AOD use-associated patient care were assessed via a pre- and post-survey instrument with 4 domains: Resident Knowledge, Resident Competence, Resident Skills and Attitudes (Alcohol), and Resident Skills and Attitudes (Drug). Responses to the pre- and post-surveys (N = 365) were compared and analyzed with t tests and Wilcoxon signed-rank tests.
RESULTS: The diverse modalities allowed each of the residency programs to adapt and implement the SMaRT curriculum based on their needs and environments. Residents' knowledge, skills, and attitudes regarding SBIRT and working with unhealthy AOD use, as assessed by survey, generally improved after completing the SMaRT curriculum, despite the variety of models used. Specifically, Resident Knowledge and Resident Competence domains significantly improved (P < .000). Residents improved the least for survey items within the Resident Skills and Attitudes (Alcohol) domain.
CONCLUSIONS: Adaptable curricula, such as SMaRT, may be a viable step towards developing a nationwide curriculum.

PMID: 28332942 [PubMed - as supplied by publisher]

Adolescent substance use: Assessing the knowledge, attitudes, and practices of a school-based health center workforce.

Thu, 03/23/2017 - 5:35pm
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Adolescent substance use: Assessing the knowledge, attitudes, and practices of a school-based health center workforce.

Subst Abus. 2017 Feb 08;:1-7

Authors: Ramos MM, Sebastian RA, Murphy M, Oreskovich K, Condon TP

Abstract
BACKGROUND: Recent attention has focused on the potential for school-based health centers (SBHCs) to provide access points for adolescent substance use care. In 2015, the University of New Mexico began screening, brief intervention, and referral to treatment (SBIRT) training for providers at New Mexico Department of Health (NMDOH)-funded SBHCs across the state. This study assesses baseline knowledge, attitudes, and practices of the New Mexico SBHC provider workforce regarding adolescent substance use and provision of services.
METHODS: In early 2015, the NMDOH administered an SBHC provider workforce survey (N = 118) and achieved a 44.9% response rate. This descriptive analysis includes all survey respondents who self-identified as a primary care or behavioral health provider in an SBHC serving middle or high school students (n = 52).
RESULTS: Among respondents, the majority (57.7%) were primary care providers, including nurse practitioners, physicians, and physician assistants. The remaining 42.3% of respondents were master's-level behavioral health providers. Only 44.2% of providers reported practicing the full SBIRT model at their SBHC, and 21.2% reported having received continuing education on SBIRT within the previous 3 years. Most respondents, 84.6%, agreed that it is the responsibility of SBHC providers to screen students for substance use using a standardized tool, and 96.2% agreed that it is the responsibility of the SBHC provider to assess for students' readiness to change. A majority reported self-efficacy in helping students achieve change in their alcohol use, illicit drug use, and prescription drug misuse: 73.1%, 65.4%, and 63.5%, respectively.
CONCLUSIONS: These results suggest that SBIRT training for New Mexico SBHC providers is timely. The authors identified gaps between recommended SBIRT practices and SBIRT delivery as well as discrepancies between reported provider self-efficacy and actual implementation of the SBIRT model. Further study will determine the effectiveness of efforts to address substance use and implement SBIRT in SBHCs.

PMID: 28328312 [PubMed - as supplied by publisher]

Referral to treatment for hospitalized medical patients with an alcohol use disorder: A proof-of-concept brief intervention study.

Thu, 03/23/2017 - 5:35pm
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Referral to treatment for hospitalized medical patients with an alcohol use disorder: A proof-of-concept brief intervention study.

Soc Work Health Care. 2017 Mar 21;:1-14

Authors: Berger L, Hernandez-Meier J, Hyatt J, Brondino M

Abstract
Substance misuse intervention in healthcare settings is becoming a US national priority, especially in the dissemination and implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT). Yet, the referral to treatment component of SBIRT is understudied. This proof-of-concept investigation tested an enhanced coordinated hospital-community two session brief intervention designed to facilitate the referral to treatment of hospitalized medical patients with an alcohol use disorder. Participants (N = 9) attended the second session of the brief intervention held in the community in most cases (56%), while one out of three (33%) received some level of post-brief intervention alcohol and/or other drug treatment. Alcohol use and alcohol-related problems also statistically improved. Based, in part, on the results plus the widespread dissemination of SBIRT, next step investigations of brief interventions to help bridge hospitalized medical patients in need to community substance abuse treatment are warranted.

PMID: 28323548 [PubMed - as supplied by publisher]

A randomized controlled trial of a brief intervention for alcohol and drugs linked to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in primary health care in Chile.

Thu, 03/02/2017 - 4:34pm
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A randomized controlled trial of a brief intervention for alcohol and drugs linked to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in primary health care in Chile.

Addiction. 2017 Feb 27;:

Authors: Poblete F, Barticevic NA, Zuzulic MS, Portilla R, Castillo-Carniglia A, Sapag JC, Villarroel L, Sena BF, Galarce M

Abstract
AIM: To study the effectiveness of a Brief Intervention (BI) associated with the ASSIST (Alcohol Smoking and Substance Involvement Screening Test) for alcohol and illicit drug use as part of a systematic screening program implemented in primary care.
DESIGN: A multi-center randomized open-label trial stratified using the ASSIST-specific substance involvement score (for alcohol, scores ranged from 11 to 15 and 16 to 20; and for the other substances, from 4 to 12 and 13 to 20).
SETTING: Primary care centers (n = 19), local small emergency rooms (n = 8), and police stations (n = 5) in Chile.
PARTICIPANTS: 12,217 people between 19 and 55 years old were screened for moderate alcohol and drug use risk defined by ASSIST Chilean version, differing from standard version on a lower cut-off point for upper end of moderate-risk drug users (21 instead 27). 806 non-treatment-seekers were randomized. Intervention and comparison ASSIST-linked BI (n = 400) compared with an informational pamphlet on risk associated with substance use (n = 406).
MEASUREMENTS: Total ASSIST alcohol and illicit involvement score (ASSIST - AI), and ASSIST-specific score for alcohol, cannabis, and cocaine, at baseline and at three-month follow-up.
FINDINGS: Sixty-two percent of participants completed follow up. An intention-to-treat analysis showed no difference between the two groups for the ASSIST - AI score [Mean difference -0.17, Confidence Interval (-1.87, 2.20)] (MD, CI), either for specific scores alcohol [MD 0.18, CI (-1.45, 1.10)], cannabis [MD -0.62 CI (-0.89, 2.14)], or cocaine [MD -0.79 CI (-2.89, 4.47)].
CONCLUSION: It is not clear whether a brief intervention associated with the Alcohol Smoking and Substance Involvement Screening Test (ASSIST) is more effective than an informational pamphlet in reducing alcohol and illicit substance consumption in non-treatment-seeking, primary care users with moderate risk.

PMID: 28239995 [PubMed - as supplied by publisher]

Efficacy of a universal smoking cessation intervention initiated in inpatient psychiatry and continued post-discharge: A randomised controlled trial.

Thu, 02/16/2017 - 4:34pm

Efficacy of a universal smoking cessation intervention initiated in inpatient psychiatry and continued post-discharge: A randomised controlled trial.

Aust N Z J Psychiatry. 2017 Feb 01;:4867417692424

Authors: Metse AP, Wiggers J, Wye P, Wolfenden L, Freund M, Clancy R, Stockings E, Terry M, Allan J, Colyvas K, Prochaska JJ, Bowman JA

Abstract
OBJECTIVE: Interventions are required to redress the disproportionate tobacco-related health burden experienced by persons with a mental illness. This study aimed to assess the efficacy of a universal smoking cessation intervention initiated within an acute psychiatric inpatient setting and continued post-discharge in reducing smoking prevalence and increasing quitting behaviours.
METHOD: A randomised controlled trial was undertaken across four psychiatric inpatient facilities in Australia. Participants ( N = 754) were randomised to receive either usual care ( n = 375) or an intervention comprising a brief motivational interview and self-help material while in hospital, followed by a 4-month pharmacological and psychosocial intervention ( n = 379) upon discharge. Primary outcomes assessed at 6 and 12 months post-discharge were 7-day point prevalence and 1-month prolonged smoking abstinence. A number of secondary smoking-related outcomes were also assessed. Subgroup analyses were conducted based on psychiatric diagnosis, baseline readiness to quit and nicotine dependence.
RESULTS: Seven-day point prevalence abstinence was higher for intervention participants (15.8%) than controls (9.3%) at 6 months post-discharge (odds ratio = 1.07, p = 0.04), but not at 12 months (13.4% and 10.0%, respectively; odds ratio = 1.03, p = 0.25). Significant intervention effects were not found on measures of prolonged abstinence at either 6 or 12 months post-discharge. Differential intervention effects for the primary outcomes were not detected for any subgroups. At both 6 and 12 months post-discharge, intervention group participants were significantly more likely to smoke fewer cigarettes per day, have reduced cigarette consumption by ⩾50% and to have made at least one quit attempt, relative to controls.
CONCLUSIONS: Universal smoking cessation treatment initiated in inpatient psychiatry and continued post-discharge was efficacious in increasing 7-day point prevalence smoking cessation rates and related quitting behaviours at 6 months post-discharge, with sustained effects on quitting behaviour at 12 months. Further research is required to identify strategies for achieving longer term smoking cessation.

PMID: 28195010 [PubMed - as supplied by publisher]

Family Camp: A multi-disciplinary intervention for brain tumor patients and families.

Thu, 02/09/2017 - 4:34pm
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Family Camp: A multi-disciplinary intervention for brain tumor patients and families.

J Clin Oncol. 2016 Oct 09;34(26_suppl):240

Authors: Lovely M, Levinson Marks A, LaMarre AK, Chang SM, Clarke J, Patt J, Barani E

Abstract
240 Background: The diagnosis of a brain tumor is a catastrophic life changing event that impacts the entire family. Patients and caregivers experience dramatic role changes, concern for their children, financial stress, and isolation. For many, the situation is overwhelming. A novel intervention to address these needs is "Family Camp". Our vision for camp was to provide respite to the entire family, decrease caregiver stress, improve family connections and promote a sense of understanding and connection with the community at large.
METHODS: In a unique partnership with the widow of a former patient, the members of the UCSF Neuro-Oncology Division created and offered a weekend camp for brain tumor patients with children. Team members included MDs, RNs, social workers, psychologists, artists, body workers, "camp counselors" and community volunteers. In addition to respite, camp was structured through art, songs, projects and games to deliver opportunities for understanding and community building, including understanding the disease and its impact on the family. Therapeutic interventions included couples activities, counseling, parenting strategies, and providing a sense of connection to others dealing with brain tumors, the health care team, and camp volunteers. Anxiety, stress, depression, coping and values based living were measured pre and post camp using DASS21, CES-D, Brief Cope, Values Based Living instruments, and survey questions.
RESULTS: 11 families attended camp for 3 days in 2014. Improvement was noted in post camp testing of depression, anxiety and stress versus pre-camp. Survey questions showed the most common and important outcome to be connection, specifically that patients, caregivers, and children made connections with similar others. Families reported being able to relax and felt taken care of. They liked the opportunity for undistracted family time, getting to know their health providers outside of the office, and couples benefited from family counseling.
CONCLUSIONS: Capitalizing on the unique skills of a multi-disciplinary team, one that includes the patient's health care team, can lead to the delivery of a novel intervention that improves the illness experience of brain tumor patients and families.

PMID: 28156540 [PubMed - in process]

The Complex Nature of Parental Substance Use: Examining Past Year and Prior Use Behaviors as Correlates of Child Maltreatment Frequency.

Thu, 02/02/2017 - 4:33pm

The Complex Nature of Parental Substance Use: Examining Past Year and Prior Use Behaviors as Correlates of Child Maltreatment Frequency.

Subst Use Misuse. 2017 Feb 01;:1-11

Authors: Kepple NJ

Abstract
BACKGROUND: Child maltreatment studies predominantly have operationalized parental substance use as dichotomous variables for any use, any harmful/risky use, or any substance use disorder (SUD). This limits our understanding about how a range of use behaviors may contribute to child maltreatment.
OBJECTIVE: Build upon prior studies by incorporating a multi-faceted approach to operationalizing parental substance use.
METHODS: Cross-sectional, secondary data analyses were conducted using the National Survey of Child and Adolescent Well-being (NSCAW I). The study used weighted negative binomial regression to examine relationships between annual child maltreatment frequency and different ways of operationalizing substance use among 2,100 parents.
RESULTS: Several, inter-related behaviors (i.e., heavy drinking, illicit drug use, polysubstance use, SUD, and prior SUD < 4 years) appeared to be relevant for understanding differences in child maltreatment frequencies. A gradient effect was detected across five substance use behavior patterns: (1) lowest estimated counts were observed for nonusers, light-to-moderate drinkers, and parents with a prior (but not past year) SUD (ӯ < 7.0), (2) slightly higher estimated count was observed for heavy drinkers and/or illicit drug users (ӯ = 9.3), and (3) highest estimated count was observed for parents with past year SUD (ӯ = 17.6). Conclusions/Importance: SUD is a critical screening criteria for potential child harm. Parents reporting risky substance use behaviors may benefit from prevention or brief intervention services related to both their substance use and parenting behaviors. Administrative systems also could benefit from detailed tracking of substance use behaviors for future program evaluation and development.

PMID: 28145806 [PubMed - as supplied by publisher]

Sensitivity and specificity of the gain short-screener for predicting substance use disorders in a large national sample of emerging adults.

Thu, 01/19/2017 - 4:32pm
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Sensitivity and specificity of the gain short-screener for predicting substance use disorders in a large national sample of emerging adults.

Addict Behav. 2017 Jan 06;68:14-17

Authors: Smith DC, Bennett KM, Dennis ML, Funk RR

Abstract
BACKGROUND AND OBJECTIVES: Emerging Adults (ages 18-25) have the highest prevalence of substance use disorders and rarely receive treatment from the specialty care system. Thus, it is important to have screening instruments specifically developed for emerging adults for use in Screening, Brief Intervention and Referral to Treatment (SBIRT) models. Optimal cutoffs for the widely-used GAIN Short-Screener's (GAIN-SS) Substance Disorder Screener (SDScrY) are not established specifically for emerging adults. Therefore, this study examined the sensitivity and specificity of the SDScrY in predicting emerging adult (ages 18-25) substance use disorders.
METHODS: We analyzed data from emerging adults in a large clinical sample (n=9,808) who completed both the five-item SDScrY (α=0.85) and the full criteria set for DSM-IV Substance Use Disorders. We estimated the sensitivity, specificity and area under the curve to determine optimal cutoffs.
RESULTS: Analyses revealed a high correlation between the SDScrY screener and its longer parent scale (r=0.95, p<0.001). Sensitivity (83%) and specificity (95%) were highest at a cutoff score of two (AUC=94%) on the SDScrY for any past year substance use disorder. Sensitivity (85%) was also high at a cutoff score of two on the SDScrY for any past year alcohol disorder.
CONCLUSIONS: The five-item Substance Use Disorder Screener is a sensitive and specific screener for emerging adults, and could be used to identify emerging adults who may benefit from SBIRT interventions.

PMID: 28088053 [PubMed - as supplied by publisher]

The SBIRT program matrix: a conceptual framework for program implementation and evaluation.

Thu, 01/12/2017 - 4:33pm
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The SBIRT program matrix: a conceptual framework for program implementation and evaluation.

Addiction. 2017 Feb;112 Suppl 2:12-22

Authors: Del Boca FK, McRee B, Vendetti J, Damon D

Abstract
BACKGROUND AND AIMS: Screening, Brief Intervention and Referral to Treatment (SBIRT) is a comprehensive, integrated, public health approach to the delivery of services to those at risk for the adverse consequences of alcohol and other drug use, and for those with probable substance use disorders. Research on successful SBIRT implementation has lagged behind studies of efficacy and effectiveness. This paper (1) outlines a conceptual framework, the SBIRT Program Matrix, to guide implementation research and program evaluation and (2) specifies potential implementation outcomes.
METHODS: Overview and narrative description of the SBIRT Program Matrix.
RESULTS: The SBIRT Program Matrix has five components, each of which includes multiple elements: SBIRT services; performance sites; provider attributes; patient/client populations; and management structure and activities. Implementation outcomes include program adoption, acceptability, appropriateness, feasibility, fidelity, costs, penetration, sustainability, service provision and grant compliance.
CONCLUSIONS: The Screening, Brief Intervention and Referral to Treatment Program Matrix provides a template for identifying, classifying and organizing the naturally occurring commonalities and variations within and across SBIRT programs, and for investigating which variables are associated with implementation success and, ultimately, with treatment outcomes and other impacts.

PMID: 28074572 [PubMed - in process]

Screening, brief intervention and referral to treatment (SBIRT): implementation barriers, facilitators and model migration.

Thu, 01/12/2017 - 4:33pm
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Screening, brief intervention and referral to treatment (SBIRT): implementation barriers, facilitators and model migration.

Addiction. 2017 Feb;112 Suppl 2:23-33

Authors: Vendetti J, Gmyrek A, Damon D, Singh M, McRee B, Del Boca F

Abstract
AIMS: To identify barriers and facilitators associated with initial implementation of a US alcohol and other substance use Screening, Brief Intervention, and Referral to Treatment (SBIRT) grant program, and to identify modifications in program design that addressed implementation challenges.
DESIGN: A mixed-method approach used quantitative and qualitative data, including SBIRT provider ratings of implementation barriers and facilitators, staff interview responses and program documentation.
SETTING: Multiple sites within the first seven programs funded in a national demonstration program in the United States.
PARTICIPANTS: One hundred and two SBIRT providers were surveyed; 221 SBIRT stakeholders and staff were interviewed.
MEASUREMENTS: Mean ratings of barriers and facilitators were calculated using provider survey responses. An inductive content analysis of interview responses identified factors perceived to support and challenge implementation; program modifications that occurred over time were recorded.
FINDINGS: Providers rated pre-selected implementation facilitators higher than barriers. Content analysis of interview responses revealed six themes: committed leaders; intra- and inter-organizational communication/collaboration; provider buy-in and model acceptance; contextual factors; quality assurance; and grant requirements. Over time, programs tended to: adopt more efficient 'pre-screen' item sets; screen for risk factors in addition to alcohol/substance use; use contracted specialists to deliver SBIRT services; conduct services in high-volume emergency department and trauma center settings; and implement on-site and telephonic treatment delivery.
CONCLUSIONS: Screening, Brief Intervention and Referral to Treatment program implementation in the United States is facilitated by committed leadership and the use of substance use specialists, rather than medical generalists, to deliver services. Many implementation challenges can be addressed by an adequate start-up phase focused on comprehensive education and training, and on the development of intra- and inter-organizational communication and collaboration; opinion leader support; and practitioner and host site buy-in.

PMID: 28074571 [PubMed - in process]

Screening, Brief Intervention and Referral to Treatment: implications of SAMHSA&#039;s SBIRT initiative for substance abuse policy and practice.

Thu, 01/12/2017 - 4:33pm
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Screening, Brief Intervention and Referral to Treatment: implications of SAMHSA's SBIRT initiative for substance abuse policy and practice.

Addiction. 2017 Feb;112 Suppl 2:110-117

Authors: Babor TF, Del Boca F, Bray JW

Abstract
AIMS: This paper describes the major findings and public health implications of a cross-site evaluation of a national Screening, Brief Intervention and Referral to Treatment (SBIRT) demonstration program funded by the US Substance Abuse and Mental Health Services Administration (SAMHSA).
METHODS: Eleven multi-site programs in two cohorts of SAMHSA grant recipients were each funded for 5 years to promote the adoption and sustained implementation of SBIRT. The SBIRT cross-site evaluation used a multi-method evaluation design to provide comprehensive information on the processes, outcomes and costs of SBIRT as implemented in a variety of medical and community settings.
FINDINGS: SBIRT programs in the two evaluated SAMHSA cohorts screened more than 1 million patients/clients. SBIRT implementation was facilitated by committed leadership and the use of substance use specialists, rather than medical generalists, to deliver services. Although the quasi-experimental nature of the outcome evaluation does not permit causal inferences, pre-post differences were clinically meaningful and statistically significant for almost every measure of substance use. Greater intervention intensity was associated with larger decreases in substance use. Both brief intervention and brief treatment were associated with positive outcomes, but brief intervention was more cost-effective for most substances. Sixty-nine (67%) of the original performance sites adapted and redesigned SBIRT service delivery after initial grant funding ended. Four factors influenced SBIRT sustainability: presence of program champions, availability of funding, systemic change and effective management of SBIRT provider challenges.
CONCLUSIONS: The US Substance Abuse and Mental Health Services Administration's Screening, Brief Intervention and Referral to Treatment (SBIRT) demonstration program was adapted successfully to the needs of early identification efforts for hazardous use of alcohol and illicit drugs. SBIRT is an innovative way to integrate the management of substance use disorders into primary care and general medicine. Screening, Brief Intervention and Referral to Treatment implementation was associated with improvements in treatment system equity, efficiency and economy.

PMID: 28074569 [PubMed - in process]

The relative impact of brief treatment versus brief intervention in primary health-care screening programs for substance use disorders.

Thu, 01/12/2017 - 4:33pm
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The relative impact of brief treatment versus brief intervention in primary health-care screening programs for substance use disorders.

Addiction. 2017 Feb;112 Suppl 2:54-64

Authors: Aldridge A, Dowd W, Bray J

Abstract
AIMS: To assess the relative impact of brief treatment (BT) compared with brief intervention (BI) on changes in substance use behavior in primary care screening programs for substance use disorders, overall and by patient severity.
DESIGN AND PARTICIPANTS: A total of 9029 patients with both baseline and follow-up interviews were identified in the US Government Performance and Results Act (GPRA) data from October 2004 and February 2008. Using a propensity score framework, multiple generalized linear mixed models and a local linear matching method with a difference in difference estimator, patients from the BI group that resemble BT patients were used to determine the relative treatment effect of BT. A total of 3218 of these US patients with baseline and follow-up interviews were used in the final analysis sample after the propensity score-matching procedure (1448 patients assigned to a BI service category and 1770 assigned to a BT service category).
SETTING: United States.
MEASUREMENTS: Dependent variables were the number of days of use in the past 30 days of any alcohol, alcohol to intoxication, illicit drugs and marijuana.
FINDINGS: The relative impact of BT was not significant for alcohol (0.269; P > 0.1) or alcohol to intoxication (0.462; P > 0.1). BT was found to reduce the frequency of use of illicit drugs at follow-up by 0.634 days more than BI (P < 0.05). Marijuana days were not affected significantly by assignment to BT (-0.128; P > 0.1). Higher severity patients assigned to BT had a decrease in days of illicit drug use of 1.765 (P < 0.05).
CONCLUSIONS: In the United States, brief treatment appears to have a stronger impact on reducing illicit drug use than brief intervention but is similar to brief intervention for reducing alcohol use, alcohol to intoxication and marijuana use alone.

PMID: 28074568 [PubMed - in process]

The cost-effectiveness of brief intervention versus brief treatment of Screening, Brief Intervention and Referral to Treatment (SBIRT) in the United States.

Thu, 01/12/2017 - 4:33pm
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The cost-effectiveness of brief intervention versus brief treatment of Screening, Brief Intervention and Referral to Treatment (SBIRT) in the United States.

Addiction. 2017 Feb;112 Suppl 2:73-81

Authors: Barbosa C, Cowell A, Dowd W, Landwehr J, Aldridge A, Bray J

Abstract
AIMS: To conduct a cost-effectiveness analysis (CEA) comparing the delivery of brief intervention (BI) with brief treatment (BT) within Screening, Brief Intervention and Referral to Treatment (SBIRT) programs.
DESIGN: Quasi-experimental differences in observed baseline characteristics between BI and BT patients were adjusted using propensity score techniques. Incremental comparison of costs and health outcomes associated with BI and BT.
SETTING: Health-care settings in four US states participating in Substance Abuse and Mental Health Services Administration SBIRT grant programs.
PARTICIPANTS: Ninety patients who received BT and 878 who received BI.
MEASUREMENTS: Per-patient cost of SBIRT, patient demographics and six measures of substance use: proportion using alcohol, proportion using alcohol to intoxication, days of alcohol use, days of alcohol use to intoxication, proportion using drugs and days using drugs.
FINDINGS: BI and BT were associated with better outcomes. The cost of SBIRT was significantly higher for BT patients ($75.54 versus 16.32, 95% confidence interval, P < 0.01). BT would be cost-effective if the decision-maker had a willingness to pay of $8.90 for a 1 percentage point reduction in the probability of using any alcohol. For the other five outcomes, BT was less effective and more costly, and BI would be a better use of resources.
CONCLUSIONS: It might be cost-effective to offer brief treatment if the goal is to abstain from alcohol. However, the higher effectiveness of brief treatment for this outcome is associated with considerable uncertainty and, because both brief intervention and brief treatment improve all outcomes, brief treatment does not appear to be a good use of resources.

PMID: 28074567 [PubMed - in process]

Screening, Brief Intervention and Referral to Treatment (SBIRT): rationale, program overview and cross-site evaluation.

Thu, 01/12/2017 - 4:33pm
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Screening, Brief Intervention and Referral to Treatment (SBIRT): rationale, program overview and cross-site evaluation.

Addiction. 2017 Feb;112 Suppl 2:3-11

Authors: Bray JW, Del Boca FK, McRee BG, Hayashi SW, Babor TF

Abstract
AIMS: Since 2003, the US Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment (SAMHSA, CSAT) has awarded 32 Screening, Brief Intervention and Referral to Treatment (SBIRT) grants to states, territories and tribal organizations to enhance services for persons with, or at risk for, substance use disorders. The grants supported an expansion of the continuum of care to include screening, brief intervention, brief treatment and referral to treatment in general medical and community settings. This paper describes the SAMHSA SBIRT program in the context of the scientific research that motivated its development, as well as the two cross-site evaluations that are the subject of subsequent papers in this Supplement.
METHODS: A narrative review of research evidence pertaining to SBIRT and of the cross-site evaluation design that made it possible to determine whether the SAMHSA SBIRT grant program achieved its intended aims. The 11 programs within the two cohorts of grant recipients that were the subject of the cross-site evaluations are described in terms of SBIRT service components, performance sites, providers, management structure/activities and patient/client characteristics.
CONCLUSION: The US SAMHSA SBIRT program is an effective way to introduce a variety of new services that extend the continuum of care for substance-involved individuals, ranging from early intervention with non-dependent substance users to referral of more serious cases to specialized substance abuse treatment.

PMID: 28074566 [PubMed - in process]

Sustaining SBIRT in the wild: simulating revenues and costs for Screening, Brief Intervention and Referral to Treatment programs.

Thu, 01/12/2017 - 4:33pm
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Sustaining SBIRT in the wild: simulating revenues and costs for Screening, Brief Intervention and Referral to Treatment programs.

Addiction. 2017 Feb;112 Suppl 2:101-109

Authors: Cowell AJ, Dowd WN, Mills MJ, Hinde JM, Bray JW

Abstract
AIMS: To examine the conditions under which Screening, Brief Intervention and Referral to Treatment (SBIRT) programs can be sustained by health insurance payments.
DESIGN: A mathematical model was used to estimate the number of patients needed for revenues to exceed costs.
SETTING: Three medical settings in the United States were examined: in-patient, out-patient and emergency department. Components of SBIRT were delivered by combinations of health-care practitioners (generalists) and behavioral health specialists.
PARTICIPANTS: Practitioners in seven SBIRT programs who received grants from the US Substance Abuse and Mental Health Services Administration (SAMHSA).
MEASUREMENTS: Program costs and revenues were measured using data from grantees. Patient flows were measured from administrative data and adjusted with prevalence and screening estimates from the literature.
FINDINGS: SBIRT can be sustained through health insurance reimbursement in out-patient and emergency department settings in most staffing mixes. To sustain SBIRT in in-patient programs, a patient flow larger than the national average may be needed; if that flow is achieved, the range of screens required to maintain a surplus is narrow. Sensitivity analyses suggest that the results are very sensitive to changes in the proportion of insured patients.
CONCLUSIONS: Screening, Brief Intervention and Referral to Treatment programs in the United States can be sustained by health insurance payments under a variety of staffing models. Screening, Brief Intervention and Referral to Treatment programs can be sustained only in an in-patient setting with above-average patient flow (more than 2500 screens). Screening, Brief Intervention and Referral to Treatment programs in out-patient and emergency department settings can be sustained with below-average patient flows (fewer than 125 000 out-patient visits and fewer than 27 000 emergency department visits).

PMID: 28074564 [PubMed - in process]

A time and motion study of Screening, Brief Intervention, and Referral to Treatment implementation in health-care settings.

Thu, 01/12/2017 - 4:33pm
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A time and motion study of Screening, Brief Intervention, and Referral to Treatment implementation in health-care settings.

Addiction. 2017 Feb;112 Suppl 2:65-72

Authors: Cowell AJ, Dowd WN, Landwehr J, Barbosa C, Bray JW

Abstract
AIMS: Screening and brief intervention for harmful substance use in medical settings is being promoted heavily in the United States. To justify service provision fiscally, the field needs accurate estimates of the number and type of staff required to provide services, and thus the time taken to perform activities used to deliver services. This study analyzed the time spent in activities for the component services of the substance misuse Screening, Brief Intervention and Referral to Treatment (SBIRT) program implemented in emergency departments, in-patient units and ambulatory clinics.
DESIGN: Observers timed activities according to 18 distinct codes among SBIRT practitioners.
SETTING: Twenty-six US sites within four grantees.
PARTICIPANTS: Five hundred and one practitioner-patient interactions; 63 SBIRT practitioners.
MEASUREMENTS: Timing of practitioner activities.
INTERVENTIONS: Delivery of component services of SBIRT.
FINDINGS: The mean (standard error) time to deliver services was 1:19 (0:06) for a pre-screen (n = 210), 4:28 (0:24) for a screen (n = 97) and 6:51 (0:38) for a brief intervention (n = 66). Estimates of service duration varied by setting. Overall, practitioners spent 40% of their time supporting SBIRT delivery to patients and 13% of their time delivering services.
CONCLUSIONS: In the United States, support activities (e.g. reviewing the patient's chart, locating the patient, writing case-notes) for substance abuse Screening, Brief Intervention and Referral to Treatment require more staff time than delivery of services. Support time for screens and brief interventions in the emergency department/trauma setting was high compared with the out-patient setting.

PMID: 28074563 [PubMed - in process]

The influence of state-level policy environments on the activation of the Medicaid SBIRT reimbursement codes.

Thu, 01/12/2017 - 4:33pm
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The influence of state-level policy environments on the activation of the Medicaid SBIRT reimbursement codes.

Addiction. 2017 Feb;112 Suppl 2:82-91

Authors: Hinde J, Bray J, Kaiser D, Mallonee E

Abstract
AIMS: To examine how institutional constraints, comprising federal actions and states' substance abuse policy environments, influence states' decisions to activate Medicaid reimbursement codes for screening and brief intervention for risky substance use in the United States.
METHODS: A discrete-time duration model was used to estimate the effect of institutional constraints on the likelihood of activating the Medicaid reimbursement codes. Primary constraints included federal Screening, Brief Intervention and Referral to Treatment (SBIRT) grant funding, substance abuse priority, economic climate, political climate and interstate diffusion. Study data came from publicly available secondary data sources.
RESULTS: Federal SBIRT grant funding did not affect significantly the likelihood of activation (P = 0.628). A $1 increase in per-capita block grant funding was associated with a 10-percentage point reduction in the likelihood of activation (P = 0.003) and a $1 increase in per-capita state substance use disorder expenditures was associated with a 2-percentage point increase in the likelihood of activation (P = 0.004). States with enacted parity laws (P = 0.016) and a Democratic-controlled state government were also more likely to activate the codes.
CONCLUSION: In the United States, the determinants of state activation of Medicaid Screening, Brief Intervention and Referral to Treatment (SBIRT) reimbursement codes are complex, and include more than financial considerations. Federal block grant funding is a strong disincentive to activating the SBIRT reimbursement codes, while more direct federal SBIRT grant funding has no detectable effects.

PMID: 28074562 [PubMed - in process]

Substance use outcomes of patients served by a large US implementation of Screening, Brief Intervention and Referral to Treatment (SBIRT).

Thu, 01/12/2017 - 4:33pm
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Substance use outcomes of patients served by a large US implementation of Screening, Brief Intervention and Referral to Treatment (SBIRT).

Addiction. 2017 Feb;112 Suppl 2:43-53

Authors: Aldridge A, Linford R, Bray J

Abstract
AIMS: To estimate changes in the substance use behaviors of patients who received services as part of the US Substance Abuse and Mental Health Services Administration's (SAMHSA) Screening, Brief Intervention and Referral to Treatment (SBIRT) grant program.
METHODS: We use a pre-post design and performance monitoring data collected by SBIRT organizations. For a sample of 17 575 patients, we compare pre-SBIRT substance use with substance use 6 months after receipt of SBIRT services. SBIRT's correlation with changes in substance use was estimated using generalized linear mixed models to account for the clustering of patients within health-care facility and US state.
RESULTS: From pre- to post-SBIRT we found large and statistically significant decreases for almost every measure of substance use. Model-adjusted means indicate that the prevalence of alcohol use was lower 6 months later by 35.6%, heavy drinking by 43.4% and illicit drug use by 75.8%. Greater intervention intensity was associated with larger decreases in substance use. The study design does not support causal conclusions and estimated decreases in reported substance use are due, at least in part, to a well-known set of confounders and natural substance use patterns that may be unrelated to any particular SBIRT intervention.
CONCLUSIONS: Compared with previously published findings on the Screening, Brief Intervention and Referral to Treatment grant program, our estimates of substance use reduction were smaller, but still consistently large in absolute magnitude and within ranges of estimates from past trials of Screening, Brief Intervention and Referral to Treatment.

PMID: 28074561 [PubMed - in process]

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