SBIRT : S creening, B rief I ntervention, R eferral to T reatment

1. SBIRT: Screening,Brief Intervention, Referral to Treatment Stephen Ferrante, M.S.W. Group Victory Managing Partner Barry University School of Social Work Professor sferrante@groupvictory.net 954-249-2323 September 27, 2013

3. Substance Abuse Severity and Level of Care Adapted from the SAMHSA TIP #34 (1999) and Institute of Medicine (1990) None Substance Abuse Severity Mild Moderate Severe Specialized Treatment Brief Intervention Primary Prevention

4. SBIRT Core Components

5. SBIRT Approach National Evidence-based Initiative for Screening, Brief Intervention, and Referral to Treatment • Engagement • Pre-Screening: Risk Identification • Screening & Assessment: Risk Intensity • Appropriate Intervention: Brief Intervention / Brief Treatment / Outpatient Treatment / Inpatient Care / Referral Ancillary Services • Discharge with Outcome Screening • Follow-up Screens

6. SBIRT Process • Universal Prescreening • Symptoms Identification Difficult • Minimal Self-Referral • Full Assessment for Positive Prescreen • Level of Risk dictates Service Type: • Screening & Feedback (SF) for negative screens • Brief Intervention (BI) for moderate risk • Brief Treatment (BT) for moderate to high risk • Referral to Treatment (RT) - high risk/problem use

7. Prescreen: Part I

8. Prescreen: Part II

9. Alcohol, Smoking, Substance Involvement Screening Test (ASSIST)World Health Organization (WHO) • Interview Style Screen Administered for Positive Prescreen • ASSIST developed to help healthcare professionals detect and manage substance use • Scores provide a “level of risk” for substance misuse and type of service that follows: • Low risk = Screening & Feedback about results • Moderate risk = indicates the need for Brief Intervention • Moderate to High Risk = Brief Treatment • High Risk = Referral to Treatment

10. Motivational InterviewingTherapeutic Alliance • People who “Screen Positive” for Substance Misuse • May be reluctant to seek help • May be ambivalent about decision to change behavior • Confrontation & Labeling may Produce “Resistance” and/or “in Denial” • Avoiding Labeling & Confrontation • Roll with Resistance • Enhance Self-Efficacy • Build Confidence in One’s Coping Strategies

11. Motivational Interviewing • Acknowledging Motivation, Readiness & Ability for Change • Meeting Individuals Where They are • Respectful Listening • Accepting Individual’s Perspective • Identifying Consequences of Problem • Facilitating Perception Shift on Impact of Problem • Empowering Individual to Generate Insights & Solutions • Expressing Belief in Person’s Capacity to Change • Offsetting Denial, Resentment & Shame

12. Early SBIRT Examples • Emergency Departments • Bernstein E, Bernstein J, Levenson S: Project ASSERT: An ED-based intervention to increase access to primary care, preventive services, and the substance abuse treatment system. Ann Emerg Med , 1997; 30:181-189. • Primary Care Practices as “Brief Physician Advice” • Fleming, MF., Manwell, LB, Barry, KL, Adams, W, & Stauffacher, EA Brief physician advice for alcohol problems in older adults: A randomized community-based trial. J FamPract; 1999 48(5): 378-84

13. SBIRT Today • Emergency Departments • Hospital Units • Primary Care Practices • Urgent Care • Federally Qualified Health Center • Health & Behavioral Health Clinic • Addiction Facilities • Educational Institutions • Community Service Settings

14. Health Care Providers can Provide SBIRT Services under Medicare • Medicare pays for medically reasonable & necessary SBIRT services in physicians’ offices & outpatient hospitals • Physicians, Physician Assistants, Nurse Practitioners, Clinical Nurse Specialists, Clinical Psychologists, or Clinical Social Workers can bill for SBIRT • To bill Medicare, providers of MH services must be: • Licensed or certified to perform mental health services by the state in which they perform the services; • Qualified to perform the specific mental health services rendered; and • Working within their State Scope of Practice Act http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/SBIRT_Factsheet_ICN904084.pdf

15. SBIRT Billing & Reimbursement • Affordable Care Act Recommended Service • Screening & Brief Intervention Reimbursement • Commercial insurance CPT codes • Medicare G codes • Medicaid HCPCS codes • Florida has not approved Medicaid Billing Codes • SAMHSA Block & SBIRT Grants

16. SBIRT Codinghttp://sbirt.samhsa.gov/coding.htm

17. Common Behavioral Health Codes

18. http://sbirt.samhsa.gov/about.htm

20. The Result: A 16-session curriculum manual for conducting brief treatment (Dupree & Schonfeld, CSAT, 2005) http://kap.samhsa.gov/products/manuals/pdfs/substanceabuserelapse.pdf

21. Questions AnswersCommentsThank You!