Screening, Brief Intervention and Referral to Treatment (SBIRT) - School-Based Health Center (SBHC) Project

About SBIRT - SBHC

The adolescent Screening, Brief Intervention, Referral to Treatment (SBIRT) - School-Based Health Center (SBHC) Project is a five-year collaborative venture between the Behavioral Health Administration (BHA) and the Colorado Department of Public Health and Environment (CDPHE). Funding is being administered through the BHA to the Colorado Department of Public Health and Environment to CDPHE-funded school-based health centers (SBHC) around Colorado in order to institutionalize SBIRT as a standard of care into existing CDPHE-funded SBHCs who are voluntarily participating in this project.

Adolescent SBIRT is a research-based approach to the identification of risky substance use and provides brief interventions and referral to treatment to those at risk of developing substance use problems. SBHCs are convenient medical clinics that offer health care to children and youth either in a school or near school grounds. SBHCs have primary care providers such as doctors, nurse practitioners and physician assistants, as well as mental health providers.

This SBIRT-SBHC project funding is supporting SBHCs across the state by:

  • Providing SBIRT universally and addressing student needs to reduce harms associated with alcohol, tobacco and other drug use, as well as commonly reported mental health concerns.
  • Reducing health disparities that impact youth substance misuse by applying Enhanced Culturally and Linguistically Appropriate Services (CLAS) Standards.
  • Developing and implementing of SBIRT curricula, including training, technical assistance and evaluation components.

BHA funding for this project runs from Sept. 10, 2017 through June 30, 2022. The funding was $1,037,000 for the first year and has increased to $1,348,000 annually. 

Resources

SBIRT-SBHC Steering Committee

A 13-15 member SBIRT Steering Committee has been assembled to inform a comprehensive, systems integration of SBIRT into school-based health centers. Learn more about the members of steering committee here.

Frequently Asked Questions
 
What is SBIRT?

SBIRT is Screening, Brief Intervention, Referral to Treatment, an evidence-based prevention practice developed by the World Health Organization to address unhealthy alcohol and other drug use among adult and adolescent patients. The United States Preventive Services Task Force, the Centers for Disease Control and other expert groups recommend SBIRT as a routine part of health care.

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 at www.colorado.gov/hcpf.

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
History

SBIRT History in Colorado

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
Contacts

To learn more about this interagency collaboration, SBHCs SBIRT, contact:

Kristina Green, SBIRT Project Coordinator
Colorado Department of Public Health and Environment
kristina.green@state.co.us| 303.692.6279