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January 25th 2018Presentation

Depression Screening &

SBIRT(Screening, Brief

Intervention and Referral to Treatment)

DSRIP Calendar

DY3April 1, 2017 –

March 30, 2018

MY4July 1, 2017 –June 30, 2018

Demonstration Year (DY)

Measurement Year (MY)

MPA Period

April 1, 2017 –June 30, 2018

SubstantiationAlgorithmBest Practice

Depression Screening agenda

Millennium MPA - Depression

SubstantiationMCC shall conduct initial medical reviewaudit. If original findings by MCC indicateless than 75% documentation accuracy,then MCC will re-audit again at a latertime.

ActivityProvide evidence of appropriatedocumentation and at least 75%documentation accuracy of depressionscreen with follow-up

Millennium MPA – Major Depression

SubstantiationSign-in sheets for education and trainingsessions.

Produce baseline reports

Provide evidence of improvement by 10%,15% or 20% over baseline

ActivityParticipate in MCC-facilitated educationand training on depression best practices

Develop and implement practice workflowto care manage patients diagnosed withMajor Depression

Produce baseline reports of patients thatreceived an initial Dx of Major DepressiveDisorder in the primary care office thathad a F/U visit w/in 12 wks. of diagnosis.

Improve F/U w/patients receiving an initialDx of Major Depression in the PCP officew/in 12 weeks of diagnosis

Depression Algorithm

BH Best Practice

Millennium MPA - SBIRTSubstantiation

Demonstrate completion of training (i.e. certificates or sign-in

sheets)

Provide workflows and quarterly reporting on number of screenings

Activity

Train at least one key clinical member per site

Implement SBIRT

But not in that particular order…

WHY is the issue of Substance Abuse Important for Primary Care Providers?(WHERE)

It is a common problemThere are health implicationsIt affects the person, family & societyWE CAN DO SOMETHING ABOUT IT!!!

Patient resistance Sensitive topic High failure rates Inadequate training Difficulty w/ linkages Work overload Staff frustration

Why not?

Prevalence of Substance Use

Prevalence for AlcoholUse and Abuse

Most damage from misuse and/or binge drinking

Early Intervention is KEY!

Builds on medical principles

WHAT is SBIRT? And HOW can we do a better job?Screening Brief Intervention and Referral to Treatment

1 Screen Initial triage for level of severity of problem

2Brief

Intervention

Optimize level of recognition and motivation to change, if needed 1-3 sessions

3Referral to

Treatment

Severity, co-morbidity, on-site capacity,routine follow-up recommended

Patient Acceptance is highIt is evidence-based (with long-term benefits)Ease of implementation by using existing staffTime-efficient and cost-effectiveCan generate additional revenue

Benefits of SBIRT (WHY)

SBIRT Algorithm

How can we do a better job?

SCREENING: WHEN? and WHO?KEYS

Routinely screen ALL patients over age 12 annually at well visit – also screen if relevant to primary complaintUse OASAS standardized instruments

Triage patient information•Non-Risky•Risky•Substance Use Disorder

WHO screens? Self-administered or by trained staff If positive screen – next steps may require further

information (BH dx, blood pressure, blood sugar)

Approved Screening Tools

**Remember to PRE-SCREEN FIRST!!

Establish a preliminary substance use diagnosisSeverity of problemIncorporate co-morbidityIdentify strengthsPerformed in primary care office setting

ASESSMENT (if patient screens positive)

NON RISKYAssessment Feedback to

Patient

Non Risky Reinforce current behaviors

Rescreen annually

BRIEF INTERVENTION

Risky Substance Use Disorder

Brief Intervention and follow-up over time

Follow-up

Encourage linkage to treatment and monitor over time

Follow-up

Build on patients’ concerns & motivation based on their goalsListen, show empathy, be non-judgmentalInvolve patient in joint decision makingCompared to standard medical advice; this is non-confrontational; clear but not directiveCan be completed in about 5-7 minutesCan be administered by PCP, NP, PA, RN, MSW, etc.

Keys to Brief Intervention*

*This is NOT an intervention as seen on TV

REFERRAL TO TREATMENTProvide LINKAGES and NOT just phone #’sEstablish bi-directional methods of communication to ensure progress of patientCan be referred on site to qualified Behavioral Health professional OR off site to licensed Behavioral Health facility

http://youtu.be/fX90j4jD9Sc Teen Example

http://youtu.be/ebsqETBWEdQ Adult Example

Brief Intervention Examples

• Many Resources available – packets will be distributed to sites

• New York State SBIRT Publications: contact Communications@oasas.ny.gov

to order additional publications

Continue quarterly Patient Engagement-including SBIRT screens

Create or update workflows to include SBIRT processes

Provide certification from 4 hours SBIRT training for at least 1 key clinician from each site

Next Steps

MILLENNIUM LINK TO 4 HOUR CERTIFICATION COURSE

https://www.hwapps.org/dsrip/new-york/mcc/training-center/courses/?task=search_course&st=sbirt&partner_type=&project=&c_require=&credit_type=&=Find+Courses

OASAS APPROVED Certification Courseshttps://cumc.co1.qualtrics.com/jfe/form/SV_1MLQ2Ub4uMqzVmB

https://www.sbirttraining.com/

http://www1.nyc.gov/site/doh/providers/health-topics/sbirt-online-learning.page

Training Videos

What –PAM/CFA/LNUWhen- FebruaryWhere- Webinar format

Next Webinar

QUESTIONS?

Contact your Millennium Collaborative Care Relationship Manager

ReferencesWHYA. L. Bahorik, D. D. Satre, A. H. Kline-Simon, C. M. Weisner and C. I. Campbell Alcohol, Cannabis, and Opioid Use Disorders, and Disease Burden in an Integrated Health Care Systemhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5291754/

REVIEWSB. Shapiro, D. Coffa and E. F. McCance-Katz A Primary Care Approach to Substance Misuse

https://www.aafp.org/afp/2013/0715/p113.pdfSAMSHA Substance Use Disorders https://www.samhsa.gov/disorders/substance-useNIDA Screening for Drug Abuse in General Medical Settings: A Resource Guide For Providers

https://www.drugabuse.gov/sites/default/files/resource_guide.pdf D. E. Jonas and J. C. Garbutt Screening and Counseling for Unhealthy Alcohol Use in Primary Care Settings https://www.ncbi.nlm.nih.gov/pubmed/28577629

IRETA Why Mainstream Healthcare Can't Ignore Substance Use http://ireta.org/2014/05/28/infographic-why-mainstream-healthcare-cant-ignore-substance-Use/?utm_

OB_GYNT. E. Wright, M. Trepan, S. J. Undersea, C. Boyce, K. Yonkers, G. Chang and A. A. Cringe The role of screening, brief intervention, and referral to treatment in the perinatal period. https://www.ncbi.nlm.nih.gov/pubmed/27373599

A. L. Suit Behavioral and Pharmacotherapy Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Women: U.S. Preventive Services Task Force Recommendation Statement http://annals.org/aim/fullarticle/2443060/behavioral-pharmacotherapy-interventions-tobacco-smoking-cessation-adults-including-pregnant-women

PediatricsAmerican Academy of Pediatrics . Prevention Substance use Screening, Brief intervention and Referral to Treatment . 2016 http://pediatrics.aappublications.org/content/pediatrics/138/1/e20161210.full.pdf

D. J. Pilowsky and L.-T. Wu Screening instruments for substance use and brief interventions targeting adolescents in primary care: A literature review http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623552/

S. J. Levy and J. F. Williams Substance Use Screening, Brief Intervention, and Referral to Treatment http://pediatrics.aappublications.org/content/pediatrics/138/1/e20161210.full.pdf

K. Harris, J. Louis-Jacques and J. R. Knight Screening and brief intervention for alcohol and other abuseAmerican College of Obstetrics and Gynecology. At Risk Drinking and Alcohol Dependence https://www.acog.org/-/media/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/co496.pdf?dmc=1&ts=20180115T1719535250L.

References (OBGyn and Pediatrics)

American College of Obstetrics and Gynecology. At Risk Drinking and Alcohol Dependence https://www.acog.org/-/media/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/co496.pdf?dmc=1&ts=20180115T1719535250L.

D'Souza-Li and S. K. Harris The future of screening, brief intervention and referral to treatment in adolescent primary care: research directions and dissemination challenges https://www.ncbi.nlm.nih.gov/pubmed/27152620

American Academy of Pediatrics Youth Screening Pocket Guide https://pubs.niaaa.nih.gov/publications/Practitioner/YouthGuide/YouthGuidePocket.pdf

K. C. Winters Brief Interventions for Adolescents https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4864856/pdf/nihms780140.pdf

N. National Guideline Clearinghouse Primary care behavioral interventions to reduce illicit drug and nonmusical pharmaceutical use in children and adolescents: U.S. Preventive Services Task Force recommendation statement. http://www.guideline.gov/content.aspx?id=47882&search=bipolar+disorder+and+child+abuse

J. E. Glass, A. M. Hamilton, B. J. Powell, B. E. Perron, R. T. Brown Specialty substance use disorder services following brief alcohol intervention: a meta-analysis of randomized controlled http://onlinelibrary.wiley.com/doi/10.1111/add.12950/abstract

S. W. Feldstein Ewing, J. M. Houck, U. Yezhuvath, E. S. Kojori, D. Truitt and F. M. Filbey The impact of therapist's words on the adolescent brain: In the context of addiction treatment http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4704857/

References (Pediatrics)

J. Vendetti, A. Gmyrek, D. Damon, M. Singh, B. McRee and F. Del Boca Screening, brief intervention and referral to treatment (SBIRT): implementation barriers, facilitators and model migration http://dx.doi.org/10.1111/add.13652 DO -10.1111/add.13652

Zhang, S. T. Li, Q. K. Lee, K. H. Chan, J. H. Kim, B. H. Yip, R. Y. Chung, A. H. Wong, Y. Fang, M. Liang and M. C. Wong Systematic Review of Guidelines on Managing Patients with Harmful Use of Alcohol in Primary Healthcare Settings https://www.ncbi.nlm.nih.gov/pubmed/28591801

K. A. Tansil, M. B. Esser, P. Sandhu, J. A. Reynolds, R. W. Elder, R. S. Williamson, S. K. Chattopadhyay, M. K. Bohm, R. D. Brewer, L. R. McKnight-Eily, D. W. Hungerford, T. L. Toomey, R. W. Hingson and J. E. Fielding Alcohol Electronic Screening and Brief Intervention: A Community Guide Systematic Review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5082433/

SAMSHA Center for Health Integration. Solutions Shared Decision Making http://www.integration.samhsa.gov/clinical-practice/shared-decision-making

Center for Medicare and Medicaid Services- SBIRT billing information https://search.cms.gov/search?utf8=%C3%A2%C5%93%E2%80%9C&affiliate=cms-new&dc=&query=SBIRT&commit=Search

C. D. Pat node, J. T. Henderson, J. H. Thompson, C. A. Singer, S. P. Forman and E. P. Whitlock Behavioral Counseling Interventions Expert Forum: Overview and Primer on U.S. Preventive Services Task Force https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0079361/

References (Implementation)

OASAS overview of SBIRT and approved screening tools. https://www.oasas.ny.gov/AdMed/sbirt/index.cfm

NIDA Chart of Evidence Based Screening Tools fore Adults and Adolescents https://www.drugabuse.gov/nidamed-medical-health-professionals/tool-resources-your-practice/screening-assessment-drug-testing-resources/chart-evidence-based-screening-tools-adults?utm_source=all+IRETA+communications&utm_campaign=fc23f1c411-EMAIL_C

NIDA Modified Assist-Quick Screening tool for Drug Use in General Medical Settings-computerized https://www.drugabuse.gov/nmassist/

NIDA Clinician's Screening Tool for Drug Use In General Medical Settings https://www.drugabuse.gov/nmassist/

NIAAA Patient and Clinician Educational https://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/clinicians_guide13_p_mats.htm

References (Screening Tools)

B. J. Turner and C. W. Mathias Increasing Prevalence of Alcohol Use Disorders: Meeting the Challenge in Primary Care 10.1007/s11606-017-4226-4 https://link.springer.com/content/pdf/10.1007%2Fs11606-017-4226-4.pdf

B. F. Grant, T. D. Saha, W. J. Ruan, R. B. Goldstein, S. P. Chou, J. Jung, H. Zhang, S. M. Smith, R. P. Pickering, B. Huang and D. S. Hasin Epidemiology of DSM-5 Drug Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions-https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2300494

W. M. Compton, C. Blanco and E. M. Wargo Integrating Addiction Services Into General Medicine https://jamanetwork.com/journals/jama/fullarticle/2474414

CDC Fact Sheet-Binge Drinking https://www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm

L. T. Wu, J. McNeely, G. A. Subramaniam, K. T. Brady, G. Sharma, P. VanVeldhuisen, H. Zhu and R. P. Schwartz DSM-5 substance use disorders among adult primary care patients: Results from a multisite study http://www.drugandalcoholdependence.com/article/S0376-8716(17)30327-7/pdf

World Health Organization The ASSIST project-Alcohol, Smoking and Substance Involvement Screening http://www.who.int/substance_abuse/activities/assist/en/

References (Epidemiology)

V. H. Murthy Surgeon General's Report on Alcohol, Drugs, and Health https://jamanetwork.com/journals/jama/fullarticle/2587685

B. K. Madras, W. M. Compton, D. Avula, T. Stegbauer, J. B. Stein and H. W. Clark Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: comparison at intake and 6 months later https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760304/

S. J. Levy and P. K. Kokotailo Substance use screening, brief intervention, and referral to treatment for pediatricianshttp://pediatrics.aappublications.org/content/pediatrics/128/5/e1330.full.pdf

M. Khara The 5A's in practice: Role Play for a Brief Intervention in Smoking https://www.youtube.com/watch?v=yzWfgjXsgr4

E. F. Kaner, F. Beyer, H. O. Dickinson, E. Pienaar, F. Campbell, C. Schlesinger, N. Heather, J. Saunders and B. Burnand Effectiveness of brief alcohol interventions in primary care populations http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004148.pub3/abstract;jsessionid=6BC1C0572C3F3966DDC2F0746E330ED4.f01t04

D. E. Jonas, J. C. Garbutt, H. R. Amick, J. M. Brown, K. A. Brownley, C. L. Council, A. J. Viera, T. M. Wilkins, C. J. Schwartz, E. M. Richmond, J. Yeatts, T. S. Evans, S. D. Wood and R. P. Harris Behavioral counseling after screening for alcohol misuse in primary care: a systematic review and meta-analysis for the U.S. Preventive Services Task Force http://annals.org/aim/fullarticle/1361859/behavioral-counseling-after-screening-alcohol-misuse-primary-care-systematic-review

J. E. Glass, K. M. Bohnert and R. L. Brown Alcohol Screening and Intervention Among United States Adults who Attend Ambulatory Healthcare https://www.ncbi.nlm.nih.gov/pubmed/26862079

M. Fiore and e. al Update Clinical Practice Guideline for Nicotine Dependence https://www.ncbi.nlm.nih.gov/books/NBK63952/

Crum and Z. B Changing mindsets to enhance treatment effectiveness http://dx.doi.org/10.1001/jama.2017.4545

References (Outcomes)

References (Outcomes)D. B. Clark, A. J. Gordon, L. R. Ettaro, J. M. Owens and H. B. Moss Screening and brief intervention for underage drinkers https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2848426/

F. W. Chi, C. M. Weiner, J. R. Mertens, T. B. Ross and S. A. Sterling Alcohol brief intervention in primary care: Blood pressureoutcomes in hypertensive patients http://dx.doi.org/10.1016/j.jsat.2017.03.009

J. F. Bobb, A. K. Lee, G. T. Lapham, M. Oliver, E. Ludman, C. Achtmeyer, R. Parrish, R. M. Caldeiro, P. Lozano, J. E. Richards and K. A. Bradley Evaluation of a Pilot Implementation to Integrate Alcohol-Related Care within Primary Care https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5615567/

C. Barbosa, A. Cowell, W. Dowd, J. Landwehr, A. Aldridge and J. BrayThe cost-effectiveness of brief intervention versus brief treatment of Screening, Brief Intervention and Referral to Treatment (SBIRT) in the United States http://dx.doi.org/10.1111/add.13658 DO - 10.1111/add.13658

M. A. Bachhuber and K. A. Bradley Evidence-Based Care for People with Unhealthy Alcohol Use-Still Elusive http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4907961/

C. Angus, N. Latimer, L. Preston, J. Li and R. Purshouse What are the Implications for Policy Makers? A Systematic Review of theCost-Effectiveness of Screening and Brief Interventions for Alcohol Misuse in Primary Care https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4150206/

A. Aldridge, R. Linford and J. Bray Substance use outcomes of patients served by a large US implementation of Screening, Brief Intervention and Referral to Treatment (SBIRT) Addiction: Vol 112 p43-53. http://onlinelibrary.wiley.com/doi/10.1111/add.13651/abstract;jsessionid=E3E4720DFD5598094880283B641A4B03.f03t03

J. Paltzer, R. L. Brown, M. Burns, D. P. Moberg, J. Mullahy, A. K. Sethi and D. Weimer Substance Use Screening, Brief Intervention, and Referral to Treatment Among Medicaid Patients in Wisconsin: Impacts on Healthcare Utilization and Costs https://www.ncbi.nlm.nih.gov/pubmed/27221694