| What is SBIRT Wyoming?
• A standard of practice that results in better healthcare.
• A proven approach that results in a reduction of substance use and healthier people.
• A small investment of time and people with big returns of improved health for people in the state of Wyoming
• Starting to be implemented in healthcare facilities and clinics statewide.
• Targets the non-dependent alcohol and other drug user.
• Health Educators come from within the local community.
• Follow-up phone conversations may be conducted by QuitLine tobacco cessation counselors to help support education and relapse prevention strategies for patients seeking help with tobacco cessation
• Supported by the Wyoming Department of Health to sustain Medicaid reimbursement for SBIRT services, provide trainings and help implement the program throughout the state.
What difference can SBIRT make in Wyoming?
• One interaction can make a difference, influencing a person's substance use and improving his or her overall health. The difference made in people’s lives can be further reaching, positively affecting their mental and emotional state as well as financial, relational, social and employment status.
• A measurable reduction in emergency and inpatient services related to alcohol and other drug use, resulting in cost savings for the healthcare system.
• Expansion of the continuum of care, focusing on prevention before alcohol and other drug use escalates to addiction.
• Reducing the rate of alcohol, tobacco and other drug use
What is SBIRT Wyoming's approach to substance abuse?
• SBIRT Wyoming treats substance use like the preventable healthcare issue it is.
• Screening and brief intervention informs people about health consequences related to substance use and reinforces responsible health behaviors.
• This approach has proven to be successful changing behavior to improve health and quality of life.
• A 10-15 minute brief intervention is very effective in empowering patients to either cut back or stop harmful substance use.
What is the SBIRT process?
A designated healthcare professional (or health educator) conducts universal screening of patients for alcohol, tobacco and other drug use using the ASSIST tool. If a patient screens positive, a brief intervention, is conducted using Motivational Interviewing techniques to establish an open and trusted dialog that encourages change. Health education and resource materials are delivered to the patient at the time of the brief intervention. On rare occasions, a patient’s screen may indicate marked alcohol or drug use. In such cases a referral to a more intensive or specialized treatment program may be made if the patient agrees. A referral coordinator or social worker may facilitate placing the patient in the right level and type of treatment option.
Where can I download the ASSIST tool?
The ASSIST screening tool can be downloaded from the website sponsored by the World Health Organization (WHO). The link to the tool is:
www.who.int/substance_abuse/activities/assist_v3_english.pdf
What population does SBIRT Wyoming help?
• SBIRT Wyoming helps Wyoming residents 18 years and older who are concerned about their health.
• People who use alcohol, tobacco and other drugs benefit from prevention screenings
• Non-dependent individuals who exhibit risky or detrimental substance use
• Health care institutions adversely affected by patient substance use.
Who can perform the SBIRT screenings?
According to the American College of Surgeons Quick Guide to Screening and Brief Intervention:
“Brief intervention does not have to be administered by a state-certified substance abuse counselor or by other clinicians with advanced training in substance abuse treatment. After relatively little training, brief intervention can be performed by anyone capable of showing respect and concern for injured patients. In addition to mental health or substance abuse counselors, the COT believes that there are multiple people in each trauma center who can meet these criteria, including surgeons and other MDs, psychologists, physician assistants, nurses, social workers and spiritual care workers.”
Your facility may choose to hire a designated health educator, train a current caring staff member or employ the use of social workers or spiritual care workers. Working within the framework of ‘who you are’ as a medical facility will individualize your program and ease transition.
Will SBIRT screenings assist in reducing the rate of tobacco use in Wyoming?
We certainly hope so! The Wyoming Department of Health specifically chose the ASSIST tool for SBIRT because it is the most comprehensive screening tool available. Substances covered include all illicit and prescription drug use, alcohol use and abuse, as well as opening a safe conversation to address tobacco use. The Wyoming QuitLine program is closely involved with SBIRT Wyoming in order to synergize and make the best use of both programs. Tobacco users motivated to take steps toward cessation during the brief intervention will be given materials from the QuitLine program and may also have the opportunity to receive a phone call for accountability and cessation counseling.
How long does a screen last?
If a person screens negative for substance, the screen can be completed in 3-5 minutes.
How long does a brief intervention take to complete?
The amount of time needed for a brief intervention varies from patient to patient and may also be dependant on the skill level of the health educator. However, on average, a BI can easily be completed in 10-15 minutes with some rare and more complicated interventions lasting up to 45 minutes.
How effective is the SBIRT program?
Admittedly, brief intervention does not work for everyone all the time but then neither again will any form of substance abuse treatment. According to SAMHSA, on a six month follow-up after a brief intervention:
• rates of illicit drug use dropped by 67.7%
• heavy alcohol use dropped by 38.6%
• no statistics are available for tobacco cessation but certainly the number of patients finding effective cessation methods will be greatly improved
A positive outcome from a brief intervention is qualified by moving a patient just one step along in the decision-making process to cut back or stop substance use. These positive outcomes are impossible to capture but motivational interviewing is an evidence-based practice proven to be highly effective in moving people toward making decisions for positive life-style change.
How can our medical facility financially support the SBIRT program?
The Substance Abuse and Mental Health Services Division of the Wyoming Department of Health is providing assistance in the form of training, service payments and help with implementation.
• SBIRT training is provided by the Wyoming Department of Health at no cost to the medical facility. These trainings include informational meetings, basic ASSIST and BI training and complete training in motivational interviewing skills.
• Medicaid codes are available for billing SBIRT services
H0049 Alcohol and/or drug screening $24
H0050 Alcohol and/or drug service, BI, per 15 minutes $48
• Private insurance company payment is currently being sought in Wyoming
The SBIRT program offers a win-win situation from the perspective of quality healthcare for patients al the way to proving increased income for medical providers.
What is the best way to implement SBIRT in our community?
The Wyoming Department of Health is looking for and identifying ‘champions’ for each community in Wyoming. These champions will help facilitate trainings and implementation procedures for medical and other facilities within the community. Several substance abuse and tobacco cessation coordinators are helping in the effort for SBIRT implementation.
Though the basic principles will remain the same, implementation may look a bit different for each institution. To meet the unique needs of patients and staff, the SBIRT process (i.e. patient flow, screeners, charting) can be adapted to meet individual clinic situations. An SBIRT trainer can offer help with precedents set at other clinics and brainstorm through patient flow but each clinic will implement a strategy that works best for them.
Is screening and brief intervention (SBI) being mandated by the Wyoming Department of Health?
No. The Wyoming Department of health highly endorses the implementation of SBIRT but the Department will not mandate the program.
The American College of Surgeons Committee on Trauma has made SBI a requirement for accreditation for trauma patients in all Level I and II trauma centers accredited by their organization . JCAHO is also considering such a requirement.
SBI is considered best case practice in all Eds and is highly recommended for all medical facilities
Who needs to be involved in implementation?
It would be ideal if everyone working in the medical facility has at least a basic knowledge of SBIRT. Even though a small percentage of employees (maybe only 1) will actually perform the SBIRT interviews, support staff will still be involved in charting, compliance, billing and follow up. Many people in your institution can contribute to successful SBI implementation because they have the talent, experience, and related work responsibilities.
In their publication ‘A Step-By-Step Implementation Guide for Trauma Centers’, the Center For Disease Control asks those implementing SBIRT to consider the following:
• Alcohol SBI is a clinical service. Is the Chief of Trauma and Trauma Nurse Coordinator (or persons with equivalent titles) involved?
• Are specialists available (e.g., orthopedics, neurosurgeons, pediatric surgeons, psychiatrists, emergency medicine, pain medicine, rehab specialists) or are nurses, social workers, clergy, or nutritionists available who might have something to contribute?
• Who is most likely to perform the Screening and deliver the Brief Interventions? They and their
• supervisors will need to be involved.
• Who will handle medical records for the service?
• Will you bill for alcohol SBI? You can bill CMS, some state Medicaid plans, and many private payers. Who from your institution should be involved in this aspect of the program?
• Will job descriptions be changed? Does HR need to help? Will other administrative services be affected?
• Do you need review by your legal staff?
How will SBIRT screens help providers?
Health Care providers have a great influence in helping people make decisions about stopping tobacco and other substance use. However, physicians often do not have the luxury of spending a lot of time with patients and many times they so not want to deal with the resistance involved with asking patients about substance use, especially non- use. By using a SBIRT health educator, a more complete clinical picture can be provided to the physician following a brief intervention. Responsibility is given to the patient to speak to the physician about the results of a positive screening or permission can be obtained from the patient for the health educator to speak with the provider. Motivational interviewing is a process that finds the internal motivation of the patient to help them move toward harms reduction. This relieves the burden from physicians who come up against resistance when trying to make patients quit.
How often should SBIRT screens be conducted?
An annual interview is more than sufficient but if a patient screens positive follow up with a health educator on progress or commitment can be assessed on subsequent visits.
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