SBIRT-SBHC Project

What is SBIRT?

According to SAMHSA, SBIRT is a comprehensive, integrated, public health approach to the delivery of early intervention and treatment services for persons with substance use disorders, as well as those who are at risk of developing these disorders.What are the core components of SBIRT?

Screening (S): Uses validated questions, self-administered by patients or administered by a member of the health care team, to determine quantity and frequency of alcohol or other drug use. Electronic screening formats are available. Screening results and patient characteristics such as age, gender and health status determine the level of intervention needed. Learn more about validated screening tools at ImprovingHealthColorado.org.

Brief Intervention (BI): A brief 5-10 minute conversation with patients at-risk for health or other negative consequences of alcohol or drug use. The brief intervention uses motivational interviewing to provide feedback, explore ambivalence, enhance motivation to change, and collaborate with the patient to set a goal to cut back or in some cases entirely quit using alcohol or drugs. Linking feedback and encouragement to change alcohol or drug use to a patient's chief concerns or health problems may increase effectiveness. Even one brief intervention may lead to change. Multiple brief interventions are often more effective.

Referral to Treatment (RT): Provided to patients who report higher risk alcohol or drug use or meet criteria for a severe alcohol or drug use disorder. A referral typically includes further evaluation by a specialist, and specialized services such as counseling and in some cases medications to address alcohol and drug use and co-occurring health or mental health problems. Follow-up and ongoing care coordination is essential for effective referrals. Find resources at ImprovingHealthColorado.org.

How effective is SBIRT?

The evidence for SBIRT is strongest as an early intervention approach to address alcohol use in adults who do not have a severe alcohol use disorder. It is a promising practice in adolescents to address tobacco, alcohol, marijuana and other drug use. As part of comprehensive preventive services, SBIRT can improve health outcomes and quality of life. Follow-up data from clinics and hospitals in Colorado that provided SBIRT demonstrated clinically meaningful decreases in at-risk alcohol, marijuana and other drug use after a brief intervention provided by a health educator. SBIRT may produce cost savings for health care systems by reducing use of emergency and in-patient services, and improving health outcomes. Read more about preliminary cost savings and recommendations for SBIRT in Colorado in the SBIRT Cost Analysis Report and SBIRT Assessment with Recommendations Report.

How can I incorporate SBIRT into my practice?

An interdisciplinary team approach is the most efficient way to provide SBIRT. For example, a medical assistant may initiate screening and record the results in the electronic medical record. Brief preliminary screening questions can be included as part of the intake process similar to brief screening for tobacco use or depression. Patients with a positive brief screening result may receive further screening with a validated questionnaire such as the AUDIT for alcohol use. Routine screening may occur annually or at every visit like a vital sign, which is often the most efficient approach.

Different members of the health care team may provide the brief interventions including primary care practitioners, social workers, nurses, health educators, or other team members. Arranging referrals for further assessment and treatment of more serious alcohol or drug use problems, follow-up and ongoing care coordination are most effective when carried out by a multidisciplinary care team.
What about reimbursement for SBIRT?

SBIRT is covered by Medicaid in Colorado, Medicare and some commercial health plans. Learn more on the Colorado Department of Health Care Policy and Financing website.

Where can SBIRT be implemented?

Although initially developed as a primary care prevention practice, SBIRT has been successfully implemented in many settings including, emergency departments, inpatient hospital units, schools, college health centers, employee assistance programs, mental health centers and others.

SBIRT Colorado (SBIRT CO) was funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) in two consecutive 5-year grants from 2006-2016. This funding was administered by the Colorado Department of Human Services, Office of Behavioral Health, implemented by Peer Assistance Services and evaluated by the OMNI Institute.

These are core highlights from 10 years of SBIRT:

• SBIRT CO facilitated the screening of more than 170,000 patients across the state and reached more than 15,000 health professionals through trainings and presentations.
• 23 clinics and hospitals around Colorado implemented SBIRT, many additional sites not tracked through the grant were also trained and began implementing SBIRT.
• There are benefits identified for patients in the SBIRT Colorado follow-up study, including 39.5% decrease in number of days using alcohol and
• 21.7% decrease in number of days using cannabis in the past 30 days.
• 88% of patients screened were very or extremely satisfied with SBIRT
• SBIRT CO partnered with the state Medicaid office to activate SBIRT billing codes, allowing for provider reimbursement.
• SBIRT CO helped moved health care settings towards establishing SBIRT as a standard of care. Like hypertension or tobacco screening, screening and brief intervention for substance use is a preventive service that should be offered routinely.
• A plethora of SBIRT tools were created for health educators and clients:
  • Alcohol/Drug Fact Cards
  • Pocket Cards for patients
  • Examine Room Posters
  • SBIRT guidelines

To learn more about the SBIRT-SBHC Project, contact:

Kristina Green, SBIRT-SBHC Project Manager
Colorado Department of Public Health and Environment
kristina.green@state.co.us