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SAMHSA News - January/February 2006, Volume 14, Number 1

Screening Adds Prevention to Treatment - Part 2

Interview and Intervention

photo of health educator talking to emergency room patient
Health Educator Jenny Casselman conducts a brief intervention with "patient" Jacqueline Cornejo (a Health Education Supervisor) at Scripps Mercy Hospital.
The interview begins with the health educator offering to do something to make the patient more comfortable—bringing an extra pillow or phoning a family member, for example. The educator also explains his or her role as one of helping the doctors who will treat the patient by obtaining information about the patient's use of medications, non-medical drugs, and alcohol over the past 12 months, all of which can affect health and medical treatment.

Standard screens for alcohol and drug use such as the Alcohol Use Disorders Identification Test and the Drug Abuse Screening Test are administered verbally. Simply asking these questions can serve an educational function, Mr. Ayala says, because patients often respond with uninformed statements such as, "I don't drink alcohol, I just drink beer."

After the educator determines the patient's level of consumption, he or she presents an evidence-based, clinically appropriate intervention. Non-users and those at low risk for abuse receive an educational message that congratulates and encourages them to continue their healthy practices.

Persons found to be at risk because of overconsumption but not yet dependent on drugs or alcohol receive a single, brief, non-judgmental intervention that explains how their consumption compares to medically accepted limits and what the possible consequences may be.

The intervention also encourages patients to change their use patterns. Individuals at high risk because of excessive consumption—but not dependent—receive an appropriate brief intervention plus a referral for one to seven sessions of brief treatment conducted by a specially trained master's- or doctoral-level clinician. These sessions may take place within the same medical setting or at another location.

Finally, persons found to be at severe risk and dependent on alcohol or drugs receive a brief intervention plus referral to a specialized treatment program. CASBIRT can cover the cost of some specialized treatment for people lacking health coverage, but "not more than 15 percent of the dollar value of the grant may be expended in specialty treatment," Mr. Stegbauer says.

The health educator also conveys to the physician the information gathered from the patient's screening for use during the examination. Once the patient has seen the doctor and is preparing to leave the emergency room, the health educator may follow up with "another little reminder," Mr. Ayala says. The patient is told to expect followup by telephone as well.

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Creating Effectiveness

The SBIRT program can reduce drug and alcohol use dramatically, followup data show. "The program's raw data show that of at-risk, high-risk, or severe-risk individuals, 62 percent reported stopping drug use and 60 percent reduced their alcohol consumption to low-risk levels," says Mr. Stegbauer.

Preliminary SBIRT data show a total of 74 percent of high-risk individuals reported lowering their drug or alcohol consumption after one or more brief treatment sessions, and 48 percent reported stopping use.

CASBIRT works in part because patients truthfully reveal their behavior, even though it may include the use of illegal substances. "There is a large body of research literature showing that self-report on drug and alcohol use is accurate," says Ms. Peek. "The health care setting is a very effective environment to elicit the truth."

"We're sensitive to the jeopardy concerns that are around these issues, but our focus is on referring each patient to appropriate treatment," Mr. Stegbauer says. "So far, we haven't had any problems." That said, continuing concerns for patients include privacy issues, loss of access to public benefits, and potential reports to health insurance providers.

Another key to success is the quality of the peer health educators. CASBIRT candidates must be bilingual in English and Spanish and have at least a high school diploma and several years' work experience, preferably with public contact. But the "intangibles" are far more important than paper credentials, says Ms. Peek. Peer health educators "absolutely have to be engaging, confident self-starters, because they're going to be dealing not just with the patients but with the doctors" and other hospital staff.

Training includes theory as well as field experience in working with both patients and the protocols and documentation forms used in the interactions. In addition, all aspects of their work are closely monitored and documented. "Our screening form is designed to capture every single aspect of everything they do, as part of our intensive quality assurance system," Ms. Peek says.

But for all the careful training, "you can't train the heart" needed to convey real compassion, Mr. Ayala says. "You've got to already have that."

Because CASBIRT uses peer health educators rather than more highly credentialed professionals to do screening, it also is cost-effective. "We're very encouraged with results thus far," Mr. Stegbauer says.

Adds Mr. Ayala, "This is prevention at its most dynamic."

For more information on the SAMHSA Screening, Brief Intervention, Referral, and Treatment program, visit the SAMHSA Web site at www.samhsa.gov/Matrix/programs_
End of Article

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Current SBIRT Projects

SAMHSA awarded funding in 2003 to six states and one tribal council over 5 years for the Screening, Brief Intervention, Referral, and Treatment program. A short description follows of each grantee:

  • California is expanding the San Diego model (see Screening Adds Prevention to Treatment—Part 1) to other clinics, emergency rooms, and trauma centers.

  • Alaska's Cook Inlet Tribal Council is serving Alaska Natives in Anchorage.

  • Illinois is providing services at hospitals, emergency rooms, and clinics in Cook County.

  • New Mexico is targeting rural and non-ethnic populations in three of its five health regions.

  • Pennsylvania is serving targeted populations of adults in general medical and other community settings in five counties.

  • Texas is providing services within the Harris County Hospital District in the Houston metropolitan area.

  • Washington State is serving five hospital emergency departments in counties with the largest volume of emergency room patients.

In addition, SAMHSA recently awarded 12 grants for brief interventions with college and university students at risk of substance abuse. For more information, visit SAMHSA's Web site at www.samhsa.gov/news /newsreleases/
End of Article

« See Part 1: Screening Adds Prevention to Treatment

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Inside This Issue

Screening Adds Prevention to Treatment
Part 1
Part 2

From the Administrator: The Value of Screening

Officials Plan for Flu Pandemic

Mental Health Campaign for Hurricane Survivors

Transforming State Mental Health Systems

The Road Home: Veterans Conference Planned

Two Reports: Substance Use Among Veterans

Town Hall Meetings Planned on Underage Drinking

Underage Drinkers Seek Help in Emergency Rooms

SAMHSA Grant Opportunities

"Fine Line" Detailed in Portraits

Rebuilding Afghanistan's Mental Health System
Part 1
Part 2

Statistics Released on School Services

Adolescents, Adults Report Major Depression

Guidelines Released on Marijuana Counseling

2006 Recovery Month Web Site Launched

Reach Out Now!

Advisory Available on Acamprosate

SAMHSA News Information

SAMHSA News - January/February 2006, Volume 14, Number 1

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