Reposted from the NH Citizen's Health Initiative...

Screening, Brief Intervention, Referral and Treatment: An Important Component in Health Reform

by John F. Bunker, ScD, MHS
President, New Futures

There are many different pieces to the new federal health care law, and many different organizations trying to make sense of how the law will impact New Hampshire. Our organization, New Futures, is one of those organizations. New Futures is a nonprofit, nonpartisan advocacy organization working to reduce underage alcohol problems and increase access to treatment in New Hampshire.

For several years, one area of interest New Futures has been examining and promoting Screening, Brief Intervention, Referral, and Treatment (SBIRT) — a solid, evidence-based model. 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. Primary care offices, hospital emergency rooms, trauma centers, and other community settings provide opportunities for early intervention with at-risk substance users before more severe consequences occur. A key aspect of SBIRT is the integration and coordination of screening components into a system of services.

The benefits of SBIRT are clear. SBIRT research has shown that large numbers of individuals at risk of developing serious alcohol or other drug problems may be identified through primary care screening. Interventions, such as SBIRT, have been found to decrease the frequency and severity of drug and alcohol use, reduce the risk of trauma, and increase the percentage of patients who enter specialized substance abuse treatment. In addition to decreases in substance abuse, screening and brief interventions have also been associated with fewer hospital days and fewer emergency department visits. Cost-benefit and cost-effectiveness analyses have demonstrated net-cost savings from these strategies.

SBIRT is not new to New Hampshire. Several practices and hospitals are doing part, or all, of the SBIRT model. For example, a few years ago St. Joseph’s Hospital identified alcohol misuse as a significant contributor to traumatic injuries in the hospital’s trauma patient population. Susan Barnard, RN and Trauma Coordinator at St. Joseph’s Hospital, leads the implementation of SBIRT in the hospital’s trauma centered. The hospital has successfully tailored a program for their patient population and available resources. Ms. Barnard recently spoke about the work being done to expand SBIRT. She stated, “In February of 2009 NH hospitals had the opportunity to receive SBIRT training from the BNI-ART Institute SBIRT program from Boston Medical Center. This venture was financed by the Trauma Program at Dartmouth Hitchcock Medical Center and organized by me. While all 26 hospitals in NH were invited to this training, we had representation from 16 different facilities. This was a fantastic opportunity and I would love to see SBIRT programs grow and expand in our state.”

The success of SBIRT is transferable to other settings. Katy Burchett, LICSW at Child Health Services recently hosted SBIRT training in the Teen Health Clinic at Child Health Services. This primary care setting began using SBIRT in late 2009. Ms. Burchett stated “the Teen Health Clinic has been very excited about the success of the program –we are already seeing a change in both behavior and ‘perception of risk’ among participants in this project. We have also been very excited to have access to excellent SBIRT training through the BNI-ART Institute/BU School of Public Health.”

As part of my work with the Citizens Health Initiative in 2007-2008, we were able to convene a half-day workshop that brought together a group of health care professionals and administrators to discuss SBIRT. About ten organizations in New Hampshire were represented. As we learned from St. Joseph’s Hospital and Child Health Services, New Hampshire has not stood still in the past three years. However, our state has a long way to go. We need to understand the opportunities presented in the new health reform law for expanding the SBIRT model throughout the system. State and community leadership should pull health care professionals and administrators together again to leverage our existing resources, identify the barriers, and coordinate the expansion of this evidence- based model.

New Hampshire has been successful in SBIRT implementation in some areas. But between parity legislation and the new health care law opportunities abound to expand SBIRT throughout New Hampshire’s public health and health care delivery systems. While we do not know the details, we do know that screening, brief interventions and referral to treatment is important work with roles for a wide variety of people and organizations.