AL-SBIRT: Screening, Brief Intervention, and Referral to Treatment in Alabama proposes to implement SBIRT practices in West Alabama that will cover alcohol, tobacco, and drug use in patients at two Federally Qualified Health Centers (FQHC) and one VA Medical Center (VAMC). The program design is guided by the need to reduce harmful and hazardous alcohol and drug use, improve associated mental health problems, reduce related healthcare costs, and to close the treatment gap between residents who have a substance abuse problem and those receiving services. The target population has health disparities due to lower income status, lack of insurance and financial resources, and a lack of a regular source of care. AL-SBIRT program staff will work with the clinical partners to incorporate SBIRT into their operations. A Health Educator will work with the FQHCs and the VAMC to provide education to both clinicians and patients on health, substance use, and mental health. Public service announcements will be used throughout the project to increase awareness and service utilization. Licensed Counselor/Social Workers will be placed at the points of care to conduct SBIRT and provide care coordination and follow-up. A specialized referral process has been developed with the Alabama Department of Mental Health and Opioid Treatment Centers. Transportation and language assistance will also be available. The project goals and objectives are to: increase access to SBIRT for adults in primary care settings; ensure SBIRT as the standard of care in Alabama's healthcare settings; improve health and behavioral outcomes among adults, including veterans, with substance use disorders and with co- occurring mental illness. The project will pre-screen 17,793 adults annually, for a five-year project total of 88,965. Of this total, 26,690 will receive a full assessment and at least brief intervention.

The Hawaii Screening, Brief lntervention and Referral to Treatment (HI-SBIRT) project incorporates SBIRT services into primary care settings across the State. HI-SBIRT estimates that approximately 3,250 screenings, 2,340 brief interventions and 780 brief treatments or referrals to treatment will be completed in year one. The initial settings for HI-SBIRT implementation as a standard practice will be six of the State's Federally Qualified Health Centers (FQHCs). These FQHCs serve unique communities at increased risk for health disparities, and include specific subpopulations such as individuals experiencing homelessness, immigrants from Micronesia, individuals with limited English-proficiency, adults with serious mental illness, specific ethnic populations with a disproportionate burden of chronic disease, LGBTQ individuals, and persons with or at risk for HIV/AIDS. As the project progresses, SBIRT practices will expand to 25 smaller non-FQHC primary care practices which will help increase the participant base and further incorporate SBIRT as a standard of primary care at all levels throughout the State. At its closing, the project's impact will be reflected in several key ways including: a higher degree of cross-professional training in SBIRT practices among primary and behavioral health professionals; a more proactive approach to addressing emerging healthcare issues (preventative healthcare) which will decrease the resources needed to treat chronic conditions (reactive healthcare ); defining a concrete referral system for individuals in need of substance abuse treatment that leaves little room for patients to "fall through the cracks;" and expanding the use of health information technology (HIT) to serve a dual purpose of 1) appropriate and timely sharing of vital patient information that better informs decision making at the point of care and 2) increasing and enhancing health data collection in a more cohesive and standardized manner.

The Oklahoma Department of Mental Health and Substance Abuse Services will partner with Community Health Centers Inc. to develop a Screening, Brief Intervention, and Referral to Treatment (SBIRT) system change initiative (SBIRT OK). SBIRT OK will implement SBIRT practices in six primary care clinics serving medically underserved populations as well as students seeking medical and counseling services at the University of Central Oklahoma. SBIRT OK will lay the foundation for a fully integrated behavioral health primary care delivery model. SBIRT OK's goals are to: (1) expand the continuum of care in Oklahoma healthcare settings to include universal and integrated SBIRT; and (2) develop the state-level infrastructure necessary to implement sustainable SBIRT services in Oklahoma. SBIRT OK will administer approximately 18,000 screens annually and a total of 91,000 screens to adult and university patients over 5 years. The project will significantly increase the number of primary and specialty healthcare patients receiving SBIRT services; decrease patient use/misuse of substances; address co-occurring behavioral health problems; promote abstinence from tobacco; and improve health and cost outcomes for participating patients and health systems. Through strategic implementation, evaluation, and promotion of SBIRT OK, Oklahoma will achieve a sustainable and replicable service model.

The Muscogee (Creek) Nation seeks to establish and maintain Screening, Brief Intervention, and Referral to Therapy (SBIRT) in the tribal clinics and hospital located within the area of north- central Oklahoma served by the tribe. This shared vision shall expand and enhance the continuum of care for substance abuse services, reduce alcohol and drug abuse and their negative impact on health, increase abstinence, reduce costly health utilization, and improve tribal health. Utilizing inclusive population-level screening, evidenced-based practices, and an aggressive care coordination and referral process that makes use of existing and newly established resources, the project shall provide the foundation for delivering and sustaining effective, efficient, and culturally appropriate substance abuse treatment services to adults in our large rural non- reservation American Indian population. The Creek Nation Many Paths project shall further identify and define the need for services, the gaps between needed and available services, barriers to services, and other problems related to the need to implement substance abuse screening and treatment services for American Indian adults. The project will serve 3,805 American Indians over the course of the project. The target population is rural non-reservation American Indian adults. Many Paths program goals are to: (1) establish, implement, and maintain SBIRT for American Indian adults who reside within the area of Oklahoma served by the Creek Nation; (2) provide treatment and ultimately reduce the prevalence of substance abuse and its impact upon American Indian adults and families who have experienced or are at risk to experience substance abuse; (3) promote systems level change at the tribal level to embrace substance abuse treatment and prevention as a core strategy.

Pennsylvania Screening, Brief Intervention and Referral to Treatment (PA-SBIRT) is being proposed by the Department of Drug and Alcohol Programs (DDAP) for the Commonwealth of Pennsylvania. PA-SBIRT will implement SBIRT training and protocols in seven primary care and community healthcare clinic sites. PA-SBIRT will use evidence-based practices using AUDIT -C, DAST and PHQ-2 screens to assess patients for harmful alcohol and drug use and co-occurring symptoms for mental health disorders. Brief interventions will be conducted with patients using the brief negotiated interview (BNI) model based on motivational interviewing principles. The project will utilize a Care Coordinator in each site who will help with the "warm-handoff' to treatment centers for patients referred to specialty substance use treatment or medication assisted treatment (MAT). These coordinators will also help track and follow-up with patients throughout the course of the project. The project team is partnering with Single County Authorities (SCAs) and local treatment providers to ensure that patients referred during the course of the five-year project are able to access the necessary treatment at the appropriate level of care. The program will also integrate health information technology (HIT) in the healthcare practices to ensure uniformity in tracking patients and ensuring their access to treatment. The Program Evaluation and Research Unit (PERU) part of the University of Pittsburgh School of Pharmacy and Directed by Dr. Janice Pringle, PhD will be leading and facilitating all evaluation efforts required for the project including continuous quality improvement efforts. The project director is Justin White, of DDAP, who has 10 years of experience with drug and alcohol intervention, treatment and education programs.

Rhode Island SBIRT (RI-SBIRT) will pre-screen approximately 30,000 individuals in year 1 and 55,000 individuals in years 2-5. The screening will cover tobacco, alcohol, marijuana and other drugs and be delivered to individuals in primary care and health centers, emergency departments, and the Department of Corrections. RI-SBIRT will be incorporated into several State priority initiatives providing connection to health and behavioral care services. These initiatives include Discharge Planning, the State Innovations Model (SIM) and the Health Equity Zones (HEZ). Through the SIM initiative, a grant focusing on the integration of health and behavioral health care across the life span, Rhode Island has created an interagency Staff Team that includes the Departments under the umbrella of the Executive Office of Health and Human Services: BHDDH, RIDOH, the Department of Human Services and the Division of Medicaid, the Office of the Health Insurance Commissioner, and Rhode Island's state health insurance exchange, HealthSource RI. The interagency team will be used as the RI-SBIRT Policy Committee post award for program implementation and policy development and to work with the Project Director to address barriers and gaps, continuously reassessing the project and making adjustments where needed. The goals of RI-SBIRT include: 1) improve the behavioral health outcomes for adults with substance use disorders; which will be achieved providing brief intervention and referral to treatment; 2) increase access to screening services to adults with primary care/health clinic settings, which will be done by training and placing Health Educators and Patient Navigators in health settings; 3) sustain and expand the RI-SBIRT throughout the State by implementing policy and payment reform, which will be the priority of the Policy Steering Committee.

The Division of Behavioral Health Prevention Program proposes a comprehensive system of Screening, Brief Intervention, Brief Treatment and Referral to Structured Treatment services including Medicated Assisted Treatment for those individuals addicted to Opioids. The project will be a State wide initiative and will involve three Cohorts of programming implementation to be implemented in phases throughout the five years of the grant. Cohort I, Phase I will include the Avera Medical Health System, which primarily includes the Eastern part of South Dakota, where we will partner with community based programs, prevention and behavioral health treatment programs. Providers selected have licensed behavioral health professionals and licensed or certified substance abuse counselors on staff. During the projects first six months, the required screening tools will be incorporated and Evidenced Based Programming will be approved by a workgroup consisting of behavioral health professionals from the local community provider system. Staff will be trained to conduct the Evidence Based Programs selected. By the seventh month of the project, the screening process within the clinics and community based services will begin. Cohort II and III will replicate the screening tools, screening process and programming in the Central part of the State by focusing on rural health care clinics and clinics operated by Indian Health Services as well as in the Western part of the State with clinics operated by the Regional Healthcare System. Program goals are to: develop organizational relationships and infrastructure for integration of SBIRT services into primary care clinics and community behavioral health systems; develop and implement SBIRT training for primary care, community health, substance abuse prevention and treatment providers; implement SBIRT services in primary care and community behavioral health settings; and monitor quality and evaluate SBIRT implementation and programming.

The proposed Virginia Screening, Brief Intervention, and Referral to Treatment (VA-SBIRT) project will be a statewide initiative that aims to develop and implement a sustainable model to increase provider training and statewide access to screening, prevention, early intervention, and treatment for substance use disorders with a focus on serving the Northern Virginia and Shenandoah Valley regions. The other three regions of the state will be afforded access to training, coaching and implementation tools. Virginia is a large and diverse state, with significant concerns around substance use that span its diverse geographic, socio-economic, and ethnic strata. VA-SBIRT's population of focus is adults 18 and over in Virginia primary care and community healthcare settings including those with and without health insurance being seen at emergency departments, county health departments, free clinics, federally qualified health centers, student health centers, and specialty clinics. VA-SBIRT's targeted specialty populations include a large student health population through three campuses at George Mason University (GMU) and patients being seen at the Prince William Health Department Sexually Transmitted Disease clinic, spanning three large, dense counties in Northern Virginia. Over the 5 year grant period, SBIRT interventions will be delivered statewide to a minimum of 20,000 unduplicated adults. In addition, GMU will develop a central data repository for all practice and referral sites. GMU will then facilitate connection to Virginia's health information exchange, ConnectVirginia, for all participating practice and referral sites.