The proposed Project ARTEMIS (AHN Researching Treatment Effectiveness and Medical Integration through SBIRT) will implement evidence-based SBIRT practices via an integrated care model at two (2) primary care sites, in Allegheny County, Pennsylvania, to increase the early identification of adult patients who are at risk for or have substance use disorders (SUDs) and facilitate their access to appropriate SUD (including medication assisted treatment (MAT)) and other behavioral health treatment services. Project ARTEMIS is a collaboration between a vertically integrated health system, Allegheny Health Network (AHN), and its Medicaid and commercial managed care organizations, Gateway Health Plan and Highmark Health Plan. AHN is in the process of building and implementing a primary care redesign strategy wherein integrated, team-based healthcare delivery models will be rolled out at 17 primary care sites throughout Western Pennsylvania by the end of 2018. An integral part of the primary care redesign initiative will be the integration of SUD and behavioral health treatment services within a new clinically integrated network (CIN). The population of focus includes patients 18 years and older within Allegheny County who may present with risky substance use or behavioral health needs at (1) Green Tree Medical Associates and (2) Wexford Health and Wellness Pavilion. This population is mostly white, English speaking, and has less than 10% of patients living below the poverty level. It is estimated that over the course of the project 25,000 patients will be served. Project ARTEMIS aims to (1) integrate SBIRT and behavioral health activities within two sites using an evidence-based framework; (2) implement an integrated, team-based care model, including evidence-based care coordination activities; (3) ensure all data is collected and reported accurately through the implementation of robust data collection and continuous quality improvement (CQI) processes; (4) evaluate the patient outcomes, cost-effectiveness, and cost-benefits of the project to demonstrate the return on investment for the cost of SBIRT implementation; (5) utilize robust CQI processes to ensure SBIRT services are carried out with fidelity and address disparities in the target population; and (6) develop a sustainable funding mechanism so healthcare providers can bill and receive reimbursement. The University of Pittsburgh School of Pharmacy, Program Evaluation and Research Unit (PERU) and RTI International are also collaborators on Project Artemis and will serve as its primary evaluators. These teams will assist with GPRA data collection and conduct quality improvement evaluations with project site staff to assess for barriers and find solutions. RTI International will collect cost and utilization data to evaluate the cost-effectiveness and cost-benefit of the provided SBIRT services.
The overarching goal of this project is to create new access to a full range of high quality SBIRT services, including medication treatment for addiction, in a statewide network of pediatric primary care practices. Even in the midst of the opioid epidemic, which has been designated a public health emergency, fewer than 10% of adolescents with a substance use disorder (SUD) ever receive treatment, and the vast majority of referrals originate in the justice system. Fewer than 2% of adolescents receiving treatment for opioid use disorder (OUD) are prescribed medications, despite clear recommendations from the AAP. The goal of integrating SBIRT and substance use services in primary care is falling short for AYA. The Adolescent Substance Use and Addiction Program (ASAP) and the Pediatric Physicians Organization of Children’s (PPOC), which are both programs within the Children’s Hospital integrated care organization, have partnered to re-envision SBIRT in pediatric primary care. In this new multidisciplinary model, a specially trained, licensed independent clinical social worker (LICSW) is brought on staff in a primary care pediatric office to deliver brief interventions, brief treatment and support referrals and serve as a bridge to the ASAP sub-specialty team of pediatric addiction medicine specialists. The LICSW functions as a fully integrated member of the primary care team - participating in team rounds and multidisciplinary care. PCPs and other staff members participate in SBIRT through administering screens, providing positive reinforcement and brief medical advice, connecting with the LICSW for warm hand-offs, prescribing medication (including for nicotine, alcohol and/or opioid use disorder), monitoring with urine drug testing as indicated, reinforcing the medical importance of substance use treatment, and helping coordinate referrals to outside providers when necessary. In addition to providing direct services, incorporating a SUD-trained LICSW elevates the practice of the PCPs by empowering them to more effectively identify and address substance use. Over the next five years, we will aim to provide high quality SBIRT services annually to more than 33,000 AYA, including brief treatment for more than 3,100 and medication treatment for opioid use disorder for more than 100 AYA within 5 years by scaling the program of integrated LICSW’s into 25 pediatric practices. Each integrated practice will be staffed with an LICSW who will provide 20 hours of SBIRT clinical services per week, and supported clinically by the team of Pediatric Addiction Medicine specialists in ASAP.
Centerstone Screening, Brief Intervention, and Referral to Treatment (C-SBIRT) will expand the continuum of care for SUD by integrating SBIRT in 14 west central Florida counties. C-SBIRT will provide screening for an unduplicated total of 42,675 adults seeking medical attention/intervention in catchment area primary care and community health settings (Yr 1: 6,000; Y 2: 9,500; Yr 3: 10,375; Yr 4: 10,600; Yr 5: 6,200) to identify risky substance use and substance use disorder (SUD) and initiate appropriate evidence-based response. C-SBIRT’s focus population comprises an estimated 3,452,580 primary care/community health patients in Charlotte, Collier, Desoto, Glades, Hardee, Hendry, Highlands, Hillsborough, Lee, Manatee, Pasco, Pinellas, Polk, and Sarasota counties. Consistent with catchment area demographics, the focus population is composed of 48% male, 52% female, 73% white, 9% African American, and 14% Hispanic/Latino adults. Subpopulations include the nearly 30% of focus population adults who are racial/ethnic minorities and the 11% who are Veterans. Approximately 23% of catchment area adults are expected to screen positive for risky substance use or substance use disorder, and 14% report poor mental health. C-SBIRT will use validated screening instruments, including the National Institute of Drug Abuse’s and National Institute of Alcoholism and Alcohol Abuse’s Single Question Screen universal pre-screenings, as well as AUDIT, DAST-10, and PHQ-9 full screening tools. SAMHSA’s Treatment Improvement Protocol (TIP) 34: Brief Interventions and Brief Therapies for Substance Abuse will provide a framework for delivering the evidence-based brief intervention, Brief Negotiated Interview, and evidence-based brief treatments, Cognitive Behavioral Therapy and Motivational Interviewing. Key C-SBIRT program components include establishing/implementing the project’s Electronic SBIRT Screening and Response System; conducting outreach, initial training, and ongoing technical assistance among catchment area providers; providing/linking patients to comprehensive SUD and co-occurring SUD and mental health disorder (COD) treatment, as appropriate; assembling the Policy Steering Committee; implementing C-SBIRT’s Quality Improvement Plan; executing C-SBIRT’s Sustainability Plan; and disseminating a comprehensive evaluation. C-SBIRT goals include: (1) Implement the project to provide comprehensive, cost-effective SBIRT; (2) Develop infrastructure and capacity to expand, enhance, and sustain project services; (3) Improve client health status/outcomes; and (4) Develop and disseminate a service model for replication. C-SBIRT will offer brief intervention, brief treatment, and/or referral to treatment to 100% receiving Intervention Team response and achieve the following measurable objectives among clients screening positive for risky substance use/SUD/COD: reduced substance/alcohol use, opioid use, mental health symptomatology, and inpatient/ER use, and increased abstinence from use. C-SBIRT will achieve 80% participant retention. C-SBIRT has secured commitments from partners dedicated to the project’s success, and will collaborate with the Central Florida Behavioral Health Network, as well as primary care, community health, specialty treatment, and Medication Assisted Treatment providers to increase implementation of cost-effective SBIRT and behavioral health expertise in primary/medical care settings; identify, reduce, and prevent risky use/SUD in the catchment area; and increase treatment engagement/retention among those with SUD/COD in the focus population.
The Community Clinics Health Network (dba Health Quality Partners) will partner with five Federally Qualified Health Centers (FQHCs) in San Diego, Riverside and Imperial Counties in Southern California to optimize and standardize Screening, Brief Intervention and Referral to Treatment (SBIRT) services through the SoCal Optimization of SBIRT (SOS) Project. The goal of the SOS Project is to uniformly optimize SBIRT services at FQHCs in the Southern California region to prevent and reduce alcohol and other substance misuse among adolescents (ages 12-17) and adults (ages 18+). This project will be implemented at 22 sites within the targeted catchment area. Participating FQHCs will be the direct service providers, administering pre-screens of their full adult and adolescent population at first visit and annually thereafter; conducting a full screen for those whose pre-screen is positive; and, depending on the score, providing brief intervention, brief treatment, in-house Medication Assisted Treatment (MAT) services or referral to external treatment. Acadia Healthcare will serve as the project’s external MAT provider and referral source for patients with more complex needs. As the lead organization, Health Quality Partners will administer the grant, provide training and technical assistance so FQHCs can fully optimize and standardize SBIRT practices, monitor all program activities, and support FQHCs to use their electronic health record to accurately code for and capture screening and follow-up information to enhance reporting for population health efforts. Project partners will utilize validated tools and evidence-based practices (e.g., cognitive behavioral therapy, motivational interviewing, MAT) with demonstrated efficacy to accomplish project goals and objectives. Health Quality Partners will develop a robust evaluation plan to assess progress and promote ongoing project improvement, collaboration and sustainability. Over the five-year project period, Health Quality Partners anticipates the following: • 545,000 patients (adults and adolescents) will be pre-screened for misuse/abuse of alcohol, tobacco and other substances; • 120,445 patients will require a full screen; • 6,142 patients will receive brief intervention; • 1,806 patients will receive brief treatment; • 2,047 patients will receive specialty treatment (in-house or external). Health Quality Partners will work collaboratively with San Diego County’s new Organized Service Delivery System to coordinate efforts and create synergy with other local ongoing substance use disorder treatment efforts.
Community Health Centers, Inc.’s (CHCI’s), Screening, Brief Intervention and Referral to Treatment (SBIRT) project: CHCI- SBIRT will target adolescents between the ages of 12 to 18 years and adults seeking medical attention and intervention services within the primary care setting. SBIRT staff will be comprised of (10.80FTE) experienced professionals who screen and provide brief interventions, brief treatment, and referral to treatment. The project will provide a culturally and linguistically appropriate continuum of care and has received commitments from other community inpatient treatment centers. In Year 1, CHCI- SBIRT will screen and treat 6,000 patients and by the end of Year 5, it is estimated that 15,000 patients will have been screened and, if screening is positive, have received and/or referred to appropriate treatment. CHCI- SBIRT will screen adolescents, beginning at age 12, and adults for depression, tobacco use, substance misuse and substance abuse disorders (SUD), as well as those diagnosed with SUD. Veterans will receive specialty screenings. CHCI- SBIRT will provide a continuum of care to address depression, reduce tobacco use, alcohol and other drug (AOD) consumption, reduce negative health impacts, increase abstinence, reduce cost and health care utilization, and promote sustainability with the continued integration of behavioral health and primary health care. Access will be increased by making referrals to CHCI’s in-house Medication Assisted Treatment (MAT) clinic, as well as area detox, outpatient and inpatient treatment facilities. The target population is unhealthy and poor. This vulnerable low-income population faces the greatest barriers to care including poverty, lack of insurance, limited access to primary care, inadequate treatment for substance abuse, and lack of transportation. CHCI providers are experienced in the integration of addiction treatment within the primary healthcare setting. CHCI also offers high-quality health and dental care, diabetes health education, cancer screenings, immunizations, and MAT substance abuse services, as well as coordinated case management within a Patient Centered Medical Home (PCMH) setting, recognized by the National Committee for Quality Assurance- Level 3. CHCI will provide free transportation via the CHCI vans or free bus tokens.
This project, titled WCHN’s SBIRT Initiative: From Training to Implementation, will implement SBIRT practices across ten primary care sites using an interdisciplinary model. All patients presenting for well visits will undergo pre-screening and if in need of further services will be referred to the practice’s integrated behavioral health consultant. This project will leverage relationships with specialty treatment providers in the community as well as ongoing SBIRT training initiatives. In 2015, Western Connecticut Health Network (WCHN) received a three-year SBIRT training grant. That project has demonstrated incredible success, having trained more students than anticipated and gained significant provider buy-in. However, because SBIRT currently is not widely practiced across our inpatient and outpatient sites, trainees are unable to consistently apply their SBIRT skills in the real world. The proposed program fills this gap and is the next logical step in WCHN’s SBIRT rollout. Populations served: The Greater Danbury and Norwalk, Connecticut communities represent a microcosm of the challenges the U.S. faces in countering alcohol and substance use disorders. Rates of binge drinking, illicit drug use, and opioid abuse are greater in these regions than in much of the U.S., as are the consequences of substance misuse, such as accidental deaths. The populations of focus for this project will be all adults and adolescents aged 16 years and older who present to participating primary care practices for an annual wellness visit. Project goals and measurable objectives: include 1) Implement pre-screening for alcohol and substance misuse at WCMG primary care sites; 2) Implement full screening for alcohol and substance misuse among patients who score positively on the pre-screen; 3) Implement brief intervention and/or referral to treatment, as applicable to individual patients; and 4) Track patient outcomes. It is anticipated that this project will serve 10,000 individuals in years 1 and 5 each, 19,000 individuals annually for years 2 through 4, and a total 30,000 individuals over the lifetime of the project. Strategies to achieve these objectives: As part of this project, alcohol and substance abuse pre-screening will be hardwired into the electronic medical record and administered to individuals aged 16 and older during wellness visits at participating primary care sites. Integrated behavioral health social workers will administer full screening to those patients who score positively on the pre-screen. Those who score positively on the full screen will receive further evaluation, brief intervention, and referral to specialty treatment, as appropriate. This project will leverage WCHN’s array of treatment offerings as well as existing relationships with specialty treatment providers to ensure timely access to treatment.
Howard University Hospital (HUH) in collaboration with Unity Health Care (Unity) Inc., the largest Federally Qualified Health Center (FQHC) in Washington, DC, propose to implement a systematic program to address alcohol or other substance misuse among patients receiving services in their primary care or prenatal clinics, emergency department, or inpatient obstetrics, medical or surgical units. Specifically, we propose to provide universal Screening Brief Intervention and Referral to Treatment (SBIRT) in these settings; ensure linkage to and retention in substance use disorder (SUD) treatment for those needing treatment, and increase SUD treatment capacity, including medication assisted treatment (MAT). Together, HUH and Unity, serve a population of approximately 160,000, including adolescents and adults, primarily from low-income, diverse minority and ethnic groups residing in Washington D.C.'s most medically underserved areas and with the greatest need for SUD, mental health and other medical services. These populations disproportionately suffer from a range of health problems, including co-occurring mental health disorders,heart disease, diabetes, chronic liver failure, high blood pressure, psychiatric illness, HIV/AIDS, and SUD. Because of the health disparities and limited primary care resources, these underserved individuals often present late in the course of the illness, with servere substance-related disorders that could have been preventable or manageable with timely diagnosis. We anticipate serving 131,577 new patients over the lifetime of the program. HUH has a wealth of experience in providing service to underserved populations and 10 years of experience implementing SBIRT programs. Consequently, in addition to implementing universal SBIRT in Unity and HUH medical programs, we are also proposing to increase the capacity of both HUH and Unity to treat SUD in programs that are integrated along with other medical services. This approach will not only improve coordination of care but will also reduce barriers to SUD treatment, including stigma and the logistical and transportation difficulties of receiving care in multiple locations. HUH-Unity SBIRT Program will be sustainable and guided by the input of internal and external advisory boards, including representation by leading experts in SBIRT, addiction medicine, clinical faculty from both sides and representatives from the District of Columbia's Department of Behavioral Health (DBH).
The Illinois Department of Human Services, Division of Alcoholism and Substance Abuse (IDHS/DASA), submits this application in response to SAMHSA FOA # TI-18-007, Screening, Brief Intervention, and Referral to Treatment (SBIRT). The expanded SBIRT services will be provided to adult patients at Silver Cross Hospital in Will County (Illinois), and the three hospitals in the Southern Illinois Healthcare (SIH) Network. Family Guidance Centers, Inc. will be responsible for the provision of SBIRT services at Silver Cross Hospital, and SIH will be responsible for the provision of SBIRT services at the hospitals in its network. Evidence is provided regarding the need for expanded hospital-based SBIRT services within this grant’s two catchment areas. This need has been exacerbated by the serious impacts of the opioid crisis within Illinois, and specific to these two areas. IDHS/DASA’s successful implementation of two SAMHSA/CSAT SBIRT cooperative agreements is described. This SBIRT grant will allow IDHS/DASA to apply this experience to the implementation of SBIRT services to geographic areas of Illinois that were not represented in these two previous awards. The persons served through this SBIRT grant will be adult hospital patients who are residents of relatively small urban areas and areas that can be characterized as rural in nature. The experience gained and lessons learned through the previous SBIRT Illinois awards were taken into account in the design and implementation plan of this grant program. SBIRT Screening and Brief Intervention (BI) services will be provided by FGC, SIH, and medical staff who complete BI training. Letters of commitment are provided from IDHS/DASA licensed and funded substance use disorder (SUD) treatment providers who will give priority to patients referred by SBIRT staff at the participating hospitals. The SUD levels of care available at these provider organizations will include an outpatient service that meets the criteria of Brief Treatment. Letters of commitment are also provided from treatment organizations who will provide access to medication assisted treatment (MAT) for patients with opioid use disorder (OUD). Delivery of the SBIRT services to be provided will be enhanced by the principles of motivational interviewing and cognitive behavioral therapy. The IDHS/DASA SBIRT implementation plan includes a Phase I start-up period that will extend no longer than four months, to be followed by the start of expanded hospital-based SBIRT services within each of the two catchment areas. It is projected that at least 40,000 unduplicated adult patients/clients will receive Illinois SBIRT services over the five years of CSAT funding. The estimated numbers of patients/clients in the Screening and Feedback Only (SF - 28,000), Brief Intervention (BI - 8,000), Brief Treatment (BT - 900), and Referral to Treatment (RT - 3,100) service categories are based on experience gained from the previous SBIRT award to Illinois, and findings reported in the professional literature. IDHS/DASA will contract with Lighthouse Institute of Illinois to implement the grant’s performance measurement plan. IDHS/DASA is requesting 995,000 in each of five years of SAMHSA/CSAT funding.
La Maestra’s project is “Expanded Screening, Brief Intervention and Referral to Treatment for low-income, uninsured and underinsured transitional age youth (TAY) and adults in San Diego County California at risk of substance-abuse. For this project La Maestra will serve low-income, uninsured and underinsured individuals in central, east and south San Diego County, California. La Maestra will screen 8,000 annually/40,000 for the project period, unduplicated TAY and adult patients for drug, alcohol misuse and depression; provide brief interventions, brief treatment, and referral to treatment including onsite substance abuse and behavioral health counseling to at least 3,000 annually/15,000 during the project period, unduplicated TAY and adult patients; and provide onsite Medication-Assisted Treatment (MAT) services to at least 300 annually/1,500 unduplicated adult patients during the five year project period. In 2017, La Maestra served 47,866 patients. According to 2017 clinic data, 77% of patients served are living at or below 200% of the federal poverty level, 22% of patients are uninsured and 80% are underinsured. In addition, 53% of patients are Hispanic/Latino and 60% prefer to be spoken to in a language other than English. In 2017, La Maestra conducted 7,019 SBIRT screenings, and diagnosed approximately 2,387 patients with substance use disorders including tobacco use and other mental health disorders. However, according to UCLA’s 2016 California Health Interview Survey (CHIS), almost 43% of adults in the service area reported needing help for self-reported mental/emotional and/or alcohol-drug issues and did not receive treatment and 19% of teens reported needing help for mental health problems, suggesting a need for more integrated behavioral health and substance abuse services into primary care within the service area. La Maestra will utilize evidence-based screening tools Alcohol Use Disorders Identification Test (AUDIT) and the Drug Abuse Screen Test (DAST-10) as well as the Patient Health Questionnaire-9 (PHQ-9) depression screening tool for all adult patients age 18 and older. For TAY, La Maestra will use the CRAFFT 2.0 to screen for high risk alcohol and other drug use disorders in youth as well as the DAST-20 adolescent version as recommended by the National Institutes of Health (NIH). All screening tools can be self-administered or administered by a clinician. La Maestra has a comprehensive and integrated behavioral health and onsite substance abuse treatment program that provides MAT. The organization is experienced at providing brief interventions, brief treatment and referrals to treatment. All providers are trained in the evidence-based practices of Motivational Interviewing (MI) and Cognitive Behavioral Therapy (CBT). In addition, for this program, La Maestra will work with The University of San Diego (UC San Diego) Health Services Research Center (HSRC) a comprehensive research unit established in 1991. HSRC resides in the Department of Family Medicine and Public Health within the UC San Diego School of Medicine with offices in San Diego and Los Angeles. As a research-based, third party evaluator HSRC will provide Program Evaluation (PE) services for this important project.
More than 1.5 million individuals, or over one-third of the state’s population, live in a rural area. This proposal focuses on improving access to health care and improving health outcomes in Pickens and Sumter counties within the state that have both a large number of square miles classified as rural and a demonstrable behavioral health burden. Under this proposal, the South Carolina Department of Alcohol and Other Drug Abuse Services (DAODAS), with the help of the South Carolina Office of Rural Health (SCORH) and the South Carolina Hospital Association (SCHA), will support the implementation of screening, brief intervention, and referral to treatment (SBIRT) in two emergency departments (EDs) experiencing a high volume of substance use-related visits. There is a significant need in South Carolina for increased access to services, particularly in the targeted communities, whose residents are socioeconomically disadvantaged and typically lack a medical home. SC SBIRT will facilitate collaborative relationships between patients’ hospitals and local SUD treatment providers and assist in future integration of behavioral health in hospital settings. The provision of SBIRT through EDs will enable peer support specialists (PSS) to reach the targeted population and reduce disparities. PSS are trained to provide recovery-support services, such as recovery coaching and connections to supportive wrap-around services (housing, support groups, etc.). Each site will be staffed with four Peer Support Specialists on a 24/7 basis to provide patient support, care coordination, follow-up, and data collection on the GPRA measures. In total, the two rural hospitals aim to see 64,095 in pre-screen, 19,229 in full screen, 15,383 in brief intervention and 4,307 in referral to treatment services.
In recent years Tennessee treatment admission for opioids have surpassed even those for alcohol and 1,631 Tennesseans died of overdose in 2016 a rise from 2015, making finding innovative solutions to the opioid crisis a top priority for the state. We intend to use this funding to develop an opioid specific approach to Screening Brief Intervention and Referral to Treatment (SBIRT) built upon our robust foundation of SBIRT for alcohol and other drugs. We will build on our previous success with the SBIRT implementation grant as well as our partner institution, Meharry Medical College's, SBIRT training grant to expand screening and enhance our referral to treatment efforts. This project will be a complement to the TN Together initiative to address the burgeoning opioid crisis in our state, and resultantly the receipt of this award will have an exponential effect on our state's ability to address substance use disorder (SUD) and OUD specifically. Through our previous SBIRT implementation grant we were able to screen thousands of Tennesseans, and provide brief intervention and referral to treatment to hundreds respectively, and these efforts have been sustained in our partner institutions. Meharry Medical College has also trained over 2,000 practicing physicians, medical residents and students in SBIRT and continues to provide this service as standard care in all of the family medicine clinics, we will combine this implementation and training experience to effectively combat substance use disorder on a wide scale while also tailoring the intervention to OUD. We will partner with both Eastern Tennessee State University, another previous partner that continues to utilize SBIRT as standard care, Meharry Medical College, and the University of Tennessee Health Science Center's Center for Addiction Science to adapt a statewide opioid focused approach to SBIRT. Our approach utilizes the frame work of SBIRT and adds the innovations that have been so effective in Rhode Island through the AnchorED intervention and the Yale ED Health study. We will use five primary strategies to adapt SBIRT to our current opioid crisis: (1) add universal opioid screening to extant protocols in primary care clinics, continuing to provide brief advice and intervention in clinic; and (2) partner with emergency departments and emergency medical services to identify non-fatal overdoses, in essence a second form of screening; and (3) utilize Advanced Peer Recovery Specialist (APRS) to provide brief negation interviews with these patients and provide either brief treatment using a form of cognitive therapy known as Seeking Safety in combination with MAT; or (4) utilize the APRS to shepherd the patients in need of treatment referral to one of our partner providers that offer behavioral as well as buprenorphine, naltrexone, and/or methadone treatments; and (5) utilize an ECHO training model to rapidly disseminate this approach across the state multiplying the effect of this funding.
Health Federation of Philadelphia (HFP) is a HRSA-funded network, comprised of more than 60 member FQHC sites throughout the Greater Philadelphia region. Over the duration of this project, HFP will provide 20 of these sites with resources, intensive training and technical assistance to implement high-fidelity SBIRT services for an estimated 50,000 adult patients. HFP will also provide training on SBIRT to behavioral health staff at its other member FQHC sites to spread the adoption of SBIRT and improve behavioral health care for an estimated 300,000 patients in the region. This project will focus on adult patients of FQHCs and addresses acute needs related to alcohol and illicit drug use. In Philadelphia alone, the drug overdose rate is three times the national rate, resulting in 900 deaths in 2016, making this project aimed at creating a systematic and sustainable continuum of services to address problematic AOD use particularly timely. Project goals include: #1) Enhance the ability of FQHCs in the Greater Philadelphia Region to identify and address the needs of patients with AOD/SUD. #2) Improve health outcomes related to AOD/SUD among patients receiving SBIRT. To reach these goals, the grantee will train SBIRT champions at each site and ensure that: a total of 50,000 patients -- 5,000 in Year 1, 10,000 in Year 2, 15,000 in Year 3, 20,000 in Year 4 are pre-screened for AOD; 15,000 -- 1,500 in Year 1, 3,000 in Year 2, 4,500 in Year 3 and 6,000 in Year 4 will be referred for full screening; 4,000 -- 400 in Year 1, 800 in Year 2, 1,200 in Year 3 and 1,600 in Year 4 receive intervention; and 500 - 50 in Year 1,100 in Year 2, 150 in Year 3, 200 in Year 4 are referred to SUD treatment. HFP will collect GPRA data on 700 unduplicated patients as a subset of the subset of the 4,000 unduplicated patients that receive post-screening SBIRT services. Further, HFP projects that 30% of those receiving SBIRT interventions will report decreased use of AOD and 25% will report improvement in mental health status. The project implementation plan includes integration of evidence-based screening instruments and interventions and will leverage the best practices for SBIRT implementation that are well documented in the literature and through publicly available resources and tool kits. HFP will also enhance the technology and data infrastructure, as well as the workforce competencies, to ensure sustainability of SBIRT beyond the 5-year grant period.
Project ASSERT 2.0 Yale New Haven Health (YNHH) Project ASSERT will provide substance use disorder (SUD) screening, intervention and referral services to patients in the Greater New Haven, Bridgeport and New London areas identified as being at risk for or having moderate or severe SUD, with an emphasis on patients who are either uninsured or covered by Medicaid. In 2016, 240,000 (19%) individuals within this catchment area received emergency or primary care from YNHH. Compared to CT as a whole, this target population is younger (median age 31.5 vs 40.6), poorer (poverty rate 25.0% vs 10.5%) and more diverse (non-white 59.6% vs 32.1%). These three cities are ranked in the top 8 of CT towns with the highest overdose deaths in 2016 and the highest need for increased access to SUD services. Our project goals are (1) Provide education on SBIRT and other evidence-based SUD treatments to providers in the identified catchment areas, (2) Ensure that medical professionals screen for SUD, (3) Expand access to evidence-based SUD treatments and (4) use data to improve care throughout the system. To achieve these goals, YNHH Project ASSERT will train providers and staff at each participating site on SBIRT, an evidence-based approach to identifying and treating individuals with SUD (1,125 providers trained over five years). In addition, we will prepare 20 or more primary care providers to prescribe buprenorphine within their practice setting. We will integrate evidence-based SUD screens within our Epic EHR to facilitate screening of patients in participating primary and emergency care settings (48,410 patients screened in Year 1; 262,933 patients over five years). Patients who screen positive will undergo further screening to assess which substances pose a risk or have contributed to an existing SUD (4,841 patients in Year 1; 26,293 unique patients over five years). This further screening will be done by a Health Promotion Advocate (HPA) located at the participating site. For patients identified as being at risk for or with a SUD, the HPA will conduct a brief intervention, the Brief Negotiation Interview (BNI). Patients with moderate to severe SUD will be navigated to treatment at a specialty treatment center located in the respective catchment area with follow-up at 30 days by the HPA. To further improve access to treatment, Project ASSERT will establish and co-locate two half-day Addiction Recovery Clinics with primary care sites in New London and Bridgeport, similar to the YNHH ARC in New Haven. Travel and prescription vouchers will also be available to patients with a demonstrated need for those supports. All screening results and SUD care plans will be documented in Epic to support a continuum of care for these patients, regardless of what YNHH facility may provide their care.