Maine SBIRT Project Getting Started Toolbox

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Eric Haram
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Joined: 07/17/2014 - 10:55
Maine SBIRT Project Getting Started Toolbox

Wanted to share these Getting Started with SBIRT tools. Hope they are helpful to those Sponsoring SBIRT implementation or for Medical Practices interested in adding Substance Abuse Screening, Brief Intervention, and Referrals to Speciality Treatment. I am currently coaching this project within Maine's larger Pt. Centered Medical Home Multi-Payor Pilot project. Attached are:
1. Brochure and On-Boarding Requirements for Medical Practices joining the SBIRT Mini Collaborative
2. Data Plan and associated graphs. These are set with formulas and will auto graph. The measures are designed to track risk stratification, numbers screened, and show rates for Brief Intervention and Brief Therapy, as well as successful referrals to speciality treatment.
3. Project Charter. This is on the classic NiaTx charter form, with built in PDSA cycles and Sustainability Structure.
4. Who Does What- This is a high level pt. flow chart of the SBIRT guideline with variations on the clinical team member who may render each of the steps. On this tool, is the data plan and suggested first steps to get started.

Remember, SBIRT is the same clinical guideline Home Health and Pt. Centered Medical Homes are using with all other designated chronic conditions. Whether depression, COPD, hyperlipidemia, diabetes, or the impact substance use has on any of the previous conditions--conducting an initial screen, leading to more standardized testing- informing an intervention that may include referral to specialists, are all the same guideline.

eric

Janis Dauer
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Joined: 06/07/2014 - 07:43

You mention applying SBIRT interventions to other chronic conditions - substance use SBIRT rarely addresses tobacco use and dependence so I wondered if you had integrated that into this project (and how). PCMH's are such an ideal venue for implementing an Ask-Advise-Refer protocol (just another way to say SBIRT) that includes state quitlines as the treatment provider in the absence of local specialists/programs. Would love to have you share whatever tools or practices you are using, if possible!

Eric Haram
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Joined: 07/17/2014 - 10:55

Hi Janis:

I'd be happy to continue to post tools as we generate, develop or borrow them. I agree, PCMH/HH's are great venues to screen and provide brief interventions around tobacco use and dependence. We have included tobacco questions in the initial Substance use screening questions. The typical Helpline response is what has been available; however the integrated BH clinicians in the PCMH practices are also able to receive referrals and provide health and behavior sessions, individually or in groups. We hope to help practices move in this direction with tobacco involved pts.

Janis Dauer
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Joined: 06/07/2014 - 07:43

Thank you - always looking for more tools! Just in case you aren't aware, most state tobacco user quitlines are much more comprehensive than commonly found in a typical helpline service. For instance, the vendor my state uses provides 240 hours of training, live supervision on every call for an initial probation period, ongoing random listening-in and regular clinical supervision by a licensed counselor, access to a medical director and monthly in-service trainings to keep current on the latest information to all of their staff from multi-disciplinary backgrounds (many of them addiction treatment) in order for them to work as a Quit Coach. The counseling they provide is evidence-based (CBT and MI techniques) and individualized. They are well-trained and competent tobacco use disorder treatment specialists, not a bank of preventive health educators dishing out canned "quit tips." They actually address tobacco use as a dependency at a level much more appropriate than the BH providers in my state (those that even bother to) who still call it "smoking cessation." I often ask them if they also do drinking cessation classes as a way to open their eyes to a more effective approach (and way to apply their KSAs to one more drug addiction). I believe there's a role to play for medical providers who do "cessation" services but a different (complimentary and synergistic) role for BH treatment specialists - similar to the difference between addressing obesity from a primary care provider's framework (as a risk factor for other diseases) and from a BH provider's perspective (treating an underlying eating disorder). It's an ideal "disorder" for learning how to integrate care since immediate patient behavior change is often not as urgently needed and the care system has quite a bit of time to figure out how to make it work within their system. Again, thank you for your willingness to share resources!