On Friday, December 6, 2013, Dr. Maja Trochimczyk, planning director at Phoenix House California, participated in a panel discussion of treatment providers convened for a special lecture on Screening, Brief Intervention and Referral to Treatment. The lecture was sponsored by the County of Los Angeles Dept. of Public Health’s Substance Abuse Prevention and Control Program along with UCLA Integrated Substance Abuse Programs, and the Pacific Southwest Addiction Technology Transfer Center.
As the main feature of this event, Dr. Sherry Larkins of UCLA presented a lecture on “Maximizing the Use of Screening, Brief Intervention, and Referral to Treatment (SBIRT) in an Era of Health Reform, Integrated Care Delivery, and Added Value.” The discussion of panelists gathered representatives from Orange County Health Care Agency and local nonprofits: Prototypes, BHS Inc., and Phoenix House.
Phoenix House has used SBIRT for adolescents in school settings in New York and Los Angeles. The local Youth and Family Counseling services was a pilot project that reached about 70 teens in northeast San Fernando Valley. The teens were screened with the COJAC Screening Tool – a free, nine-question tool developed in California by the Co-occurring Joint Action Council. After a year of operating, the program has brought valuable results and has helped to identify teens who were in need of higher-level interventions and who were then referred to outpatient, intensive outpatient and residential treatment services at Phoenix House Academy in Lake View Terrace. Unfortunately, Phoenix House’s school-based setting has made the program ineligible for federal or state funding, which only supports SBIRT in primary healthcare settings for alcohol use. The public funding for the pilot project ended, and currently school-based SBIRT is not a funded service.
According to the County, “SBIRT’s effectiveness has been proven, particularly in hospital emergency departments and trauma centers when treating individuals with alcohol-related injuries and in primary care settings when incorporated into other routine medical assessments. In the era of health care reform, SBIRT provides substance use disorder (SUD) clinicians with an excellent opportunity to import this evidence-based intervention to the new world of integrated care for added business value and improved patient outcomes.”
Dr. Larkins reviewed the need for SBIRT, described the characteristics and use of substance use screening instruments, including a comparison of their format, target populations and effectiveness. She homed in on key motivational interviewing concepts and shared principles for interacting with unmotivated and ambivalent clients, using a technique called FLO (Feedback, Listen and understand, Option explored). She discussed the use of brief intervention to raise awareness of risk and motivate change, and treatment options for patients seeking help and change, ranging from brief to long-term.
A panel of local providers with experience in SBIRT discussed the challenges, barriers, and successes they encountered. Tawny Moreno and Elaine Estrada have worked in a federally qualified health center and have served over 2,500 clients so far, finding that over 600 of them needed brief interventions. In a health care setting, the particular challenges included scheduling the brief intervention, engaging healthcare staff, and forming strong relationships with all clinic staff so that the SBIRT services would be understood as a benefit and not yet another chore to fit into a busy day. “Embedded” county screeners have to be well integrated into their healthcare setting, know the agency crisis protocols, participate in meetings, and so forth.
Brief interventions at local offices of Department of Children and Family Services, conducted by Prototypes and BHS Inc., included the use of ASSISST screener with all clients, and forming strong personal relationships as an “adviser” or “mentor” to parents threatened with losing their children due to their own substance abuse. The focus here had to remain on not converting a SBIRT intervention into a substitute long-term counseling relationship.
The Department of Health Care Services announced that SBIRT services will be available in California as of January 2014, with various restrictions on the setting, the types of healthcare professionals that can conduct these screenings and bill for them, and the types of substances screened. In accordance with the recommendation of the United States Preventive Services Task Force, only alcohol abuse will be screened at this time. After answering one question about using alcohol, patients will answer a brief screening questionnaire, to determine the level of their dependence or risky drinking.