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Northwell Health will implement Screening, Brief Intervention, and Referral to Treatment (SBIRT) in 14 identified clinical sites to increase reach within unique populations. Sites will include 3 pediatric primary care practices, 3 pediatric emergency departments, 3 pediatric behavioral health urgent care centers, 3 community-based urgent cares that serve adults and pediatrics, and two adult pain management practices. These sites have been selected based on the needs of the populations they serve, including: a) pediatric patients in primary care; b) pediatric patients seen in other healthcare settings (who may not have a primary care provider (PCP)); c) adult patients, including young adults, seen at community based urgent cares (who may not have a PCP); and d) adults in PM practices who have a higher prevalence of substance use. Settings chosen will facilitate continuity of care efforts by addressing substance use as part of usual care across the lifespan, from pediatrics to geriatrics, accounting for diverse healthcare journeys patients travel, and will serve 140,000 in the five-year grant period. Clinical settings are located in diverse, densely populated regions of metropolitan New York, including New York City, Long Island, and Westchester, an area earliest and hardest hit by COVID-19. The need is greater now than ever to identify and address substance use as part of usual patient care as stay-at-home orders, social isolation, and a lack of in-person school has contributed to increased substance use. Our strategy is based on a foundation of SBIRT, with universal screening for all patients who enter the healthcare setting. Our implementation plan will be support by interdisciplinary champions, who will drive motivation and foster an environment for program sustainability. Patients with a positive screening will be offered a brief intervention, brief treatment, or a referral to treatment by a clinical team member trained to serve as an SBIRT Health Coach. Interprofessional team members will be offered training to serve in this role, to diversify their clinical skills and assist program sustainability. Referrals to treatment will include warm hand-offs to licensed treatment providers, including for medication for addiction treatment (MAT). MAT referrals will be facilitated for patients who receive MAT induction during their healthcare visit, and for patients who are not yet in withdrawal and need a next-day induction. Ongoing brief intervention and referral to treatment services will continue in partnership with Central Nassau Guidance & Counseling through Project CONNECT. A Project CONNECT navigator will reach out to patients within 24 hours of their healthcare visit, and at days 7, 30, 60, 90, 120, and 180, to offer ongoing services and support. Navigators will also provide information on sober housing, recovery support, AA/NA, and other resources to support sustained recovery. Through this model, we will complete all required GPRA data collection, and have an opportunity to assess additional measures over time. We will assess AOD use, engagement in substance use care/treatment, and conduct ongoing quality improvement activities to drive those measures in the direction of patient recovery.

The Association for the Advancement of Mexican Americans (AAMA) is applying on behalf of an array of helping agencies in the area to address the substance problems in East Houston. The project is designed to provide holistic Screening, Brief Intervention and Referral to Treatment to the population of focus to help achieve good health, or Buena Salud in Spanish, a culturally relevant name selected for the project. The geographic catchment area for the proposed project is East Houston, TX focusing on specific zip codes with the highest density of people of color (POC): 77004 77017 77021 77023 77033 77034 77047 77048 77051 77058 77059 77061 77062 77075 77087 77089. The following are the project goals: Goal 1: Provide a Project Planning and Start-up Phase to allow for development to support the goals, objectives, and implementation of SBIRT to the pop of focus. Goal 2: Expand/enhance the continuum of care for substance use disorder (SUD) services and reduce alcohol and other drug (AOD) consumption and its negative health impact, increase abstinence, reduce costly health care utilization, and promote sustainability in the catchment area for the population focus through the implementation of SBIRT. Goal 3: Administer/oversee SBIRT operations to the population of focus to reduce underage drinking, opioid use, overdose death/ incidence rate, and other dangerous substance use. AAMA proposes to Pre/Screen 8,100, Brief Interventions for 8,415, Brief Treatment for 2,525, and Referral to Treatment for 379 individuals in Year One. Years 2-5: Pre/Screen 12,000, Brief Interventions for 1,800, Brief Treatment for 540, Referral to Treatment for 81 individuals per year for a five-year total of Pre/Screen 56,100 individuals, Brief Interventions for 8,415, Brief Treatment for 2,525, Referral to Treatment for 379 individuals. AAMA is requesting $986,612 per year for a total of $4,933,060 for SBIRT. SBIRT site partners include San Jose Health Home, CHRISTUS St. Mary’s Health Center, El Centro FQHC Health Center, and George I. Sanchez Charter Schools. Specialty Treatment Providers include Houston Treatment Center, Cenikor, Cheyenne Center, and Center for Success and Independence. The accomplishment of these goals and objectives will reduce differences in access, service use, and outcomes of services among the defined population of focus in the catchment area.

The goal of DRMM's Reaching Out program is to increase access to substance use disorder assessment, brief interventions and brief treatments, and referral to specialty treatment through the addition of SBIRT services in Detroit, Highland Park, Hamtramck, and Western Wayne County, Michigan for adults and older adults (55+) who are housing unstable, food insecure, medically under- or uninsured, or low/no income. DRMM has developed this proposal and will operate in partnership with St. Mary Mercy Hospital, which will provide Medication Assisted Treatment services to those who need it. 2,800 persons will be served over the life of the project: 360 year 1; 720 year 2; 720 year 3; 720 year 4; 360 year 5.Program objectives are: Project Director will ensure 8 or more Community Service Providers (CSP) (medical clinics, shelters, commodity distribution and senior citizen housing) embed the single question screener questions for alcohol and substances into their intake questionnaires; CSP will annually administer single question screenings of at least 160 adults to identify those in need of follow-up screening for AOD and suicide risk; Peer Recovery Coaches (PRC) will annually administer single question screenings of 200 adults in shelters to id those in need of follow-up screening for AOD and suicide risk; Case Managers, using Motivational Interviewing (MI), will assist at least 250 adults with basic sustenance items such as housing, food, or medical care to remove triggers to substance abuse or barriers to substance abuse treatment; PRC, providing peer support and using MI, will: successfully screen at least 320 adults (of whom 75 will be 55+) using the AUDIT, DAST & ASQ) as a result of referrals from community service organizations and their own outreach to shelters; engage at least 100 adults in one or more Brief Intervention (BI) using FRAMES; engage at least 60 adults in one or more Brief Treatment (BT) using Solution-focused Therapy(SFT) for AUD and SUD; ensure at least 100 adults access to Medication Assisted Therapy (MAT); engage at least 75 individuals in the population of focus group to address concrete needs like housing, food or affiliational connections; ensure at least 50 adults access formal treatment modalities other than BI or BT, including intensive outpatient (with or without domicile) residential treatment, partial hospitalization, day treatment, or withdrawal management services; There will be a 20% reduction in the assessed level[1] of alcohol or substance use from the time of intake to program discharge; There will be a sustained reduction of 10% in the assessed level of alcohol or substance use from the time of intake to 6 months following program discharge.

The RWJBarnabas Health (RWJBH) Institute for Prevention and Recovery (IFPR) will implement the SAMHSA FY 2021 Screening, Brief Intervention and Referral to Treatment (SBIRT) project to provide SBIRT services for RWJBH patients ages 12 and older and to expand and enhance the continuum of care for substance use disorder (SUD) services. New Jersey has struggled with the substance use crisis in the last decade, with a 125.0% increase in the number of drug overdose deaths from 2013 to 2018. RWJBH's catchment area primarily consists of urban and suburban locales in New Jersey. It is racially and ethnically diverse, with less than half (48.4%) of the population being non-Hispanic white. Approximately one-quarter (22.7%) of the population is Hispanic/Latino, 15.2% is Black or African-American, and 11.0% is Asian. The goals of the SBIRT program are to: 1) institute a comprehensive education and training program to educate clinical staff on protocols and best practices of SBIRT; 2) increase screening and brief interventions for individuals with SUD and those at risk for developing SUD ; 3) evaluate the impact of SBIRT in the emergency department, inpatient, and outpatient settings on patient and system outcomes; and 4) create a sustainable SBIRT implementation project for the emergency department, inpatient, and outpatient settings. The project will utilize five evidence-based practices-SBIRT, SBIRT Training of Trainers, Hilton Adolescent SBIRT, SBIRT-Mobile Health and telehealth interventions, and Systems-Level Implementation of SBIRT-to effectively assess and intervene with patients displaying moderate to high risk behaviors for SUD. The project proposes to serve 2,250,000 unduplicated individuals in Year 1, 2,500,000 unduplicated individuals in Year 2, 3,000,000 unduplicated individuals in Year 3, 3,000,000 unduplicated individuals in Year 4, and 3,000,000 unduplicated individuals in Year 5. 3,000,000 unduplicated individuals will be served over the entire project period. The project will measure progress towards goals and objectives by utilizing RWJBH's shared electronic health record, the GPRA tool, and a partnership with RTI International, which has conducted three national cross-site evaluation of SAMHSA's SBIRT program over the last two decades and will serve as the project's Evaluator.

SBIRT-CCP develops, sequentially implements, and evaluates a multidisciplinary, team-based approach to screening, brief interventions, brief treatments, and referrals to specialty care for alcohol, opioid, and other drug use in both adult and adolescent primary care. Universal pre-screening will occur annually using evidence-based instruments fully integrated into the electronic health record followed by a more in depth assessment and brief intervention (BI) for individuals deemed at risk. All at-risk individuals will be invited to join a clinical registry managed by patient care coordinators and multi-lingual advocates proficient in motivational enhancement and BI’s. Patients will be regularly re-assessed and triaged to varying intensities of collaborative care follow-up based on degree of risk, unmet social needs, patient readiness, and local clinic and treatment resources. Qualifying patients will be referred to a centralized “collaborative care team” comprised of behavioral health providers, social workers, psychiatric residents, nurse practitioners, and addiction medicine physicians for more in depth assessments, brief treatment (BT), pharmacotherapy including medication-assisted treatment (MAT), and/or facilitated referrals to specialty care. The SBIRT CCP and clinical processes will be developed and tested by the UCSF Office of Population Health in one adolescent and one adult primary care clinic in FY01 through collaborations with local SBIRT experts, implementation scientists, internal clinical champions, and community members. Using continuous feedback for iterative improvements, SBIRT CCP will be sequentially implemented in 4 additional SF adult primary care clinics in FY02-03, in adult and family medicine at UC Davis in FY03-04, and at a large FQHC family medicine system in the Central Valley in FY05 (n=26 distinct new clinics). Over 5 years, nearly 100,000 patients will receive annual pre-screens with an estimated 15,000 receiving at least one BI, 1,300 receiving BT, and 1,100 being actively referred to specialty care including MAT for opioid use disorders. These goals will be achieved by expanding and cultivating a skilled workforce to deliver efficient, evidence-based interventions within structurally and administratively prepared clinics that have tailored the CCP approach to local circumstances using internal champions and community input. Staff will be trained with in-person and distance-learning tools including x-waiver trainings supplemented by regular case conferences and a “best practices” website. Screening instruments will include the AUDIT, ASSIST, DAST, and CRAFFT and interventions will include motivational interviewing, the brief negotiated interview, cognitive-behavioral therapy, and MAT delivered by clinic staff, the CCP team, and/or contracted specialty programs. Internal champions will use previous “lessons learned,” an online implementation hub, and technical assistance to tailor the SBIRT-CCP approach, establish workflows, and collect data. Quantitative and qualitative data will be used to assess clinical and implementation processes and outcomes, cost effectiveness, and program performance.

The proposed project will build capacity to implement, evaluate, and sustain access to enhanced, timely, and culturally responsive Screening, Brief Intervention, and Referral to Treatment (SBIRT) services for substance use and comorbid psychiatric conditions, including availability of Medication-Assisted Treatment (MAT), for undergraduate and graduate college student patients seeking primary care and mental health services within a comprehensive university-based behavioral health care system which has earned national recognition for SBIRT innovation over the past 15 years. Project goals are to: 1) increase the number of college students with a SUD receiving timely and responsive brief interventions and specialty treatment, including MAT when indicated; 2) increase the number of students, including those from minoritized populations, who are receiving SBIRT services within the behavioral health care setting; 3) reduce consumption of alcohol and other substances and related negative consequences among those receiving SBIRT services; and 4) develop and implement a tobacco cessation program. We will implement a Patient-Centered Medical Home (PCMH) model that integrates health coaches, an addiction psychiatrist, and a psychologist specializing in Motivational Interviewing and Cognitive-Behavioral Therapy (CBT) for young adult substance use. Project efforts will reach approximately 15,000 patients (3,000 annually) throughout the life of the grant. Enhancing capacity will assist in saving many young lives, approximately 40% of whom live in poverty. Additionally, this project will also help us identify, understand, and disseminate what works to effectively implement SBIRT within university-based health care delivery settings serving more than 21 million college students across the United States. This project has been developed through a strategic planning process involving a Project Institutionalization Council of key campus and community stakeholders in response to a critical service need as documented by annual assessment data and records of critical incidents, including three completed suicides involving substance use and three substance overdose-related deaths during the past five years. Beyond backgrounds of poverty and marginalization, data also suggest that an increasing number of our students are arriving with established SUDs requiring comprehensive, accessible, and timely screening and follow-up treatment. Key staff members have been collaborating as a team for the past 15 years and have built capacity for SBIRT with the support of over $9 million in grants from SAMHSA, NIAAA, NIDA, and the U.S. Department of Education. Highlights of the health system's national-level accomplishments include the development of the STEPS Program, an evidence-based SBIRT protocol listed in SAMHSA's National Registry of Evidence-based Programs and Practices, as well as refereed publications and books stemming from its work on SBIRT for young adults. These accomplishments in SBIRT to date have earned national recognition through awards in behavioral health innovation and have informed the President's National Drug Control Strategy.

The Michigan Department of Health and Human Services, Office of Recovery Oriented Systems of Care (MDHHS/OROSC) intends to implement the Michigan-Promoting Healthy Lifestyles project to deliver effective Screening, Brief Intervention, and Referral to Treatment (SBIRT) services to 108,145 adolescent and adult patients in adolescent and primary health care settings to address alcohol (overuse and underage drinking), opioid, marijuana, and tobacco use, and depression. These services will be sustained through third-party reimbursement and integration between SBIRT protocols and Electronic Health Records to increase efficiencies, using the NIATx process improvement model.