Integrating Substance Use Assessment in Health Care
When a patient visits a health care setting, the visit presents an opportunity to screen for other health risks and then be referred to supportive resources. Recognizing the importance of this point of intervention, SAMHSA recently launched a new course based on a method called SBIRT(Screening, Brief Intervention, and Referral to Treatment), which walks practitioners through the process of assessing risky substance use, discussing health consequences, and referring patients to supports and treatments.
SBIRT is an intervention strategy that can take place in a wide variety of settings, with the aim to identify people who may be at risk of substance misuse or abuse. The early identification process can inform providers and guide them to appropriate referrals to treatment.
|“The course is a very useful tool to help clinicians identify and manage potential substance abuse issues in their patients.” - Aneesh Singla, M.D., M.P.H., National Spine and Pain Centers Medical Director, Rockville Center and Harvard Medical School Lecturer|
Although SAMHSA’s Medscape course was designed for physicians, nurses, nurse practitioners, pharmacists, physician assistants, social workers, dentists, and others in health care, the course will be relevant for anyone working with, or providing service to, individuals who may have substance use concerns or dependency. The free course is available on Medscape until fall 2015 and participants have the added benefit of receiving Continuing Medical Education (CME) or Continuing Education (CE) credit when the course is successfully completed.
The course prepares participants to:
- Define SBIRT
- Propose evidence-based screening strategies to identify problematic substance use
- Engage patients to discuss their substance use
- Identify various screening and assessment tools
- Understand how to use coding information for insurance reimbursement
Discussing substance use can be uncomfortable for people, so the course also walks health care workers through the process of motivational interviewing. This approach uses a style of counseling to engage in sensitive conversation, focus on what’s important to the patient, evoke motivation for change, and negotiate the next steps toward healthy changes. The curriculum guides participants through this process through a case study methodology. Through the examples of a middle-aged man using alcohol to curb family stress and an adolescent who engages in troubling marijuana use, participants have the practical experience of assessing – from the provider’s standpoint – and determining how best to respond and refer to each scenario.
|“Very comprehensive and relevant to practitioners in many fields.” – Donna Howard, Associate Professor, School of Public Health at the University of Maryland College Park|
In situations where a patient realizes the negative influence of substances and the need for change, the course highlights a “change talk” tool called “DARN-C.” “The tool illustrates the parts of a change talk conversation:
- Desire statements (I wish, I would like to…)
- Ability statements (I think I can, I am able to…)
- Reason statements (I would feel better if, I would worry less if…)
- Need statements (I should, I ought to, I have to…)
- Commitment statements (I will, I hope to, I will try to…)
Since SAMHSA’s SBIRT course launched on Medscape in September 2014, over 35,000 providers have engaged with the curriculum. One of those participants is Donna Howard, Associate Professor in the School of Public Health at the University of Maryland College Park. According to Professor Howard, “The materials provide a wealth of useful screening, treatment, and referral tools and resources. I also think this would be wonderful if disseminated and incorporated into formalized University curricula for students in public health, premed, and allied medical fields as it provides foundational knowledge and critical thinking skills. The case study methodology is highly appealing and supports interactive learning and critical skillfulness.”
In addition to developing practical skills to address substance use concerns, the course also provides important information about how to obtain reimbursement for SBIRT. Various codes approved by the American Medical Association exist for the provision of SBIRT to new or existing clients, where the services can be provided in an office, emergency department, or in-patient setting. Some insurance providers will also reimburse for advance practice nurses, psychologists, and master’s-level social workers.
The course will remain available online until fall 2015. SAMHSA also offers additional information and resources on the SBIRT program page.
- Screening, Brief Intervention, and Referral to Treatment (SBIRT) Course and Resources
- About SBIRT
- Evidence Supporting the Effectiveness of SBIRT
- National Survey on Drug Use and Health: Heavy Drinkers Unlikely to Receive Treatment
- TAP 33: Systems-Level Implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT)
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