SBIRT Screening, Brief Intervention, Refer to Treatment Chaz Molins MSW, LCSW Substance Abuse Couns

1
SBIRT Screening, Brief Intervention, Refer
to TreatmentChaz Molins MSW,
LCSWSubstance Abuse CounselorChristiana Care,
Trauma Program
2
Brief Interventions
Screenings and brief interventions (SBI) address
risky alcohol use long before it leads to health,
financial, social, spiritual, employment or
family problems. Research shows that a brief,
non-judgmental intervention by a health care
professional can have a positive, long term
impact on risky alcohol use.
3
Benefits of AOD screening among hospitalized
patients

• Better medical management of hospitalized
  patients
• Withdrawal anticipation and prevention
• Safer and more effective pain management
• Increased identification by clinicians of the
  causes of post-injury medical problems, such as
  wound infections
• Improvements in aftercare planning and treatment
• Enhancement of patient compliance
• Prevention of future AOD-relate injuries
• Reduce recidivism

4
The Christiana Experience

• Nearly 500 patients followed (2008-2009).
• Each contracted for low-risk drinking, treatment,
  or abstinence.
• Approximately 1/3 unreachable at each follow-up
  interval.
• Excellent compliance rate by report.

5

• Traffic crashes result in costs to society of
  more than 230 billion each year.
• NHTSA is focusing on four strategies that are
  crucial to making further reductions in the
  number of annual alcohol-related traffic deaths.
  Specifically, NHTSA is encouraging
• 1. Implementation of high-visibility law
  enforcement,
• 2. Support for prosecutors and DWI courts,
• 3. Increased use of medical screening and brief
  intervention for alcohol-abuse problems (SBIRT),
  and
• 4. Enactment of primary seat belt laws.

6
Impaired Driving
7
Every day, 36 people in the United States die,
and approximately 700 more are injured, in motor
vehicle crashes that involve an alcohol-impaired
driver
8
A Longitudinal Study of Former Trauma Center
Patients The Association Between Toxicology
Status and Subsequent Injury Mortality
Dischinger, Mitchell, Kufera, Soderstrom, and
Lowenfels. The Journal of TRAUMA, Injury,
Infection, and Critical Care November 2001
9
Method We followed a cohort of 27,399 trauma
patients discharged alive between 1983 and 1995
to determine subsequent mortality. Death
certificates were obtained to identify the cause
of death
10
"The results of this study, the first of its
kind, have profound health care policy
implications. We have demonstrated that, compared
with other trauma patients, patients who test
positive for alcohol or other drugs at the time
of admission to a trauma center are twice as
likely to die from a subsequent injury.
11

• Project Match, randomized trial involving
  1,635 patients at 30 sites.
• Findings Significant reduction in alcohol
  drinks/day over a 12-month follow up period as
  well as an increase in days abstinent.
• 48 reduction in return visits to ED, and 47
  reduction in readmissions to trauma programs
  (compared with the control group), after up to 3
  years follow up.

12
Components of the Brief Intervention
13
Alcohol Use Disorders Identification Test-PC
(AUDIT-PC)
14
A score of 5 or more is a positive risk
screen. Notify attending physician and document
DAR note including alcohol risk screen is
positive Answers to questions 6-9 above.
15
Components of the Brief Intervention 1) Raise
The Subject 2) Provide Feedback 3)
Enhance Motivation 4) Negotiate And Advise
16
(No Transcript)
17
Skills

• Express empathy/Reflective listening
• Develop discrepancies or inconsistencies between
  patients goals and current behavior motivates
  change (Columbo Approach).
• Normalize ambivalence.
• Avoid argument and direct confrontation.
• Adjust to clients resistance rather than
  opposing it directly.
• The client should present the arguments for
  change
• Support self-efficacy and optimism.

18
1) Raise The Subject Establish rapport
(remember, the therapeutic relationship is
the primary predictor of therapeutic success)
Raise the subject of alcohol use,
referring to previously completed
screening tool
19
2) Provide Feedback Review
patients drinking amounts and
patterns Make connection between
drinking and hospital visit Compare
patients level of drinking to national
low-risk consumption guidelines
20
3) Enhance Motivation Assess readiness to
change Develop discrepancy between
patients drinking and problems or potential
problems related to alcohol (i.e. previous
DUIs, health, difficulties at home, school or
work???)
21
4) Negotiate And Advise Negotiate
goal Give advice Summarize and
complete drinking agreement
22
(No Transcript)
23
NIAAA GuidelinesLow Risk Alcohol Consumption

24
What is Considered one drink?
25
(No Transcript)
26
(No Transcript)
27
(No Transcript)
28

• (Show clip)
• http//www.ed.bmc.org/sbirt/media/case3.html

29
Stages of Change(Its a continuum)
30
Change is a Process
31
(No Transcript)
32
Motivational Interviewing(Cliff Notes)
33
MOTIVATIONAL INTERVIEWING OVERVIEW AND TIPS
MOTIVATIONAL INTERVIEWING OVERVIEW AND
TIPSGoal To get people to resolve their
ambivalence (i.e., conflict) about changing their
behavior, while not evoking resistance (e.g.,
getting confrontational, blaming, labeling)
34
What Is Motivational Interviewing?

• A directive, client-centered counseling style.
• It elicits behavior change by helping clients
  explore and resolve ambivalence.
• It helps resolve ambivalence by increasing
  discrepancy between clients current behaviors
  and desired goals while minimizing resistance.
• During MI empathic listening is essential to
  minimizing resistance.

35
Motivational Techniques Can Help People To Change
By

• Recognizing their high risk behavior
• Evaluating how much of a problem their behavior
  is for them currently in relation to other issues
  in their life
• Looking at ways to begin the process of changing
  (e.g., identify clients strengths develop
  action plans)

36
Basic Motivational Interviewing Skills

• Ask Open-Ended Questions
• Reflective Listening
• Elicit Self-Motivational Statements
• Affirm (support, encourage, recognize clients
  difficulties)
• Summarize
• Reframing
• Developing Discrepancy
• Recognizing Ambivalence
• Looking Forward/Goal Setting
• Emphasizing Personal Choice and Control

37
Appropriate Motivational Strategies for Each
Stage of Change
38
Appropriate Motivational Strategies for Each
Stage of Change
39
Appropriate Motivational Strategies for Each
Stage of Change
40
Appropriate Motivational Strategies for Each
Stage of Change
41
Appropriate Motivational Strategies for Each
Stage of Change
42

• ALCOHOL INTOXICATION IS THE LEADING RISK FACTOR
  FOR INJURIES
• Gentilello et al, Alcohol Interventions for
  Trauma Patients Treated in Emergency Departments
  and Hospitals. Annals of Surgery. 2005
  241541-550.

43
f y i

• According to SAMHSA's 2007
• Substance Abuse Treatment Admissions
• Of 8,461 patients treated in DE,
• 975 were for alcohol only
• 1260 were alcohol and a secondary drug
• 2878-heroin and other opiates
• (presumably prescription narcotics)
• 946 - crack cocaine
• 338 - powder cocaine
• 1721 - marijuana

44
More Information and books about Motivational
Interviewing can be found on the following
websiteshttp//motivationalinterview.org/libra
ry/index.html andhttp//www.guilford.com/cgi-b
in/cartscript.cgi?pagepr/miller2.htmdirpp/AMI_s
eriesadd_promoMINTcart_id
45
Thank You !!!!!!!!!!!!!!