Utilizing Screening,Brief Intervention,and Referral to Treatment: Teaching Assessment of Substance Abuse

Although social workers regularly encounter clients with substance use problems, social work education rarely addresses addictions with any depth. This pilot study explored the use of screening, brief intervention, and referral to treatment (SBIRT) with 74 social work students. Students completed SBIRT training with pre- and post-questionnaires that assessed attitudes, knowledge, and skills concerning substance misuse. Statistically significant differences were demonstrated with students reporting more confidence in their ability to successfully assess for alcohol misuse and subsequently intervene.Substance misuse in the United States is high; 30% of adults engage in at-risk drinking.1 At-risk drinking (typically categorized as “misuse”) does not meet diagnostic criteria for abuse or dependence and is inconsistently identified. Because approximately 70% of the US adult population sees a primary care physician at least once every 2 years,2 a screening and brief intervention model for substance misuse was developed for primary care settings.Screening, brief intervention, and referral to treatment (SBIRT)3 is based on the transtheoretical model of change,4 incorporating motivational interviewing to “briefly intervene” with patients who are at-risk drinkers. The transtheoretical model presents 5 stages of client readiness to change: precontemplation (change is not considered); contemplation (some awareness of consequences but ambivalence to change); preparation (change is planned); action (change begins); and maintenance (change is managed).4 The idea is to “meet the patient where they are.” SBIRT is efficacious with assessing and intervening with at-risk drinkers in primary care settings5–7 and emergency departments8,9; however, SBIRT has not been integrated into social work education or practice.Social workers are employed in a variety of venues. Like other health care professionals, they are not necessarily trained to identify or treat misuse. Less than 10% of accredited social work programs offer a graduate certificate specific to substance abuse.10 Research shows similar barriers to screening among health care providers: lack of training to assess alcohol misuse, how to or when to screen for it, and what to do if the client indicates a need for treatment.11 Training practitioners can be effective in increasing confidence in screening and intervention as well as improving attitudes toward people with alcohol problems.12–15This pilot study assessed social work students’ attitudes, perceived skills, and knowledge of alcohol misuse before and after receiving training on SBIRT. We hypothesized that students would improve skills and knowledge of substance misuse as well as improve attitudes toward people who misuse alcohol.     

Screening,Brief Intervention,and Referral to Treatment: Public Health Training for Primary Care

Objectives. The purpose of this study was to elucidate changes in attitudes, experiences, readiness, and confidence levels of medical residents to perform screening, brief intervention, and referral to treatment (SBIRT) and factors that moderate these changes.Methods. A cohort of 121 medical residents received an educational intervention. Self-reported experience, readiness, attitude, and confidence toward SBIRT-related skills were measured at baseline and at follow-up. Analyses were conducted to evaluate the effects of medical specialization.Results. The intervention significantly increased experience (P < .001), attitude (P < .05), readiness (P < .001), and confidence (P < .001). Residents were more likely to report that their involvement influenced patients’ substance use. However, experience applying SBIRT skills varied by country of birth, specialty, and baseline scores.Conclusions. This study suggested that SBIRT training was an effective educational tool that increased residents’ sense of responsibility. However, application of skills might differ by specialization and other variables. Future studies are needed to explore and evaluate SBIRT knowledge obtained, within the context of cultural awareness and clinical skills.Substance use disorders are a major public health problem, contributing substantially to the nation''s morbidity and mortality. Substance abuse is estimated to cost more than $484 billion per year in the United States.1 Health care providers exert time and resources treating patients with substance abuse related injuries and illnesses. This suggests that health care providers have a vital role in the prevention and intervention of substance use disorders.Despite the US Preventive Services Task Force recommendation to provide screening and counseling for alcohol, tobacco, and illicit drug use among adults, pregnant women, and adolescents, many medical health care professionals face barriers and challenges providing early intervention, motivating change of behavior, facilitating access to treatment when appropriate, and improving quality of care with at-risk users.2 Barriers to providing optimal care may include deficient clinical skills and knowledge,3 negative attitudes,4 and discomfort with patient discussions about substance use.5 Studies suggest physicians report low confidence in their skills and poor satisfaction in treating substance use disorders,6,7 and often overlook the opportunity to diagnose alcohol problems in primary care settings.4,8–11 When health care professionals confront the consequences of substance abuse during patient care, they often lack the expertise to facilitate behavior change.12 Overall training in substance use related diagnosis, treatment, and prevention with chronic disease management has been inadequate for physicians.13 To address the demand for prevention and intervention in the health care setting, health care professionals must have the education and training to effectively identify substance use problems, provide behavioral counseling, and coordinate treatment. Increased education, cultural awareness, and clinical skills training of health care professionals on substance use disorders is imperative in providing quality and competent care for patients. According to the Substance Abuse and Mental Health Administration and the Office of National Drug Control Policy, screening, brief, intervention, and referral to treatment (SBIRT) is a comprehensive and integrated public health approach to the delivery of early intervention and treatment services for substance use disorders.14,15 The SBIRT approach reduces substance use consumption, improves population health, and promotes health equity through the effective integration of primary care with public health.16 Alcohol screening and brief intervention offers an evidence-based and cost-effective approach.17,18 There is strong evidence documenting the efficacy and effectiveness of screening brief intervention in reducing alcohol consumption for at-risk individuals in meta-analyses of randomized control trials and systematic reviews.19–21 In addition, the efficacy and cost effectiveness of SBIRT has been demonstrated in primary care, emergency departments, and trauma centers.22 Thus, the integration of SBIRT training for primary care residency programs lays the foundation for physician practices that may ultimately reduce substance abuse among at-risk users and dependent patients.Research suggests that medical specialization influences screening and brief interventions among physicians. Freidmann et al. 23 found that physicians practicing internal medicine and psychiatry were more likely to screen patients than family medicine or obstetrics/gynecology physicians. Also within this study, psychiatrists were most likely to attempt a brief intervention.23 However, little is known about the influence of SBIRT training on the health care providers’ attitudes, experiences, readiness, and confidence in performing SBIRT-related skills. In an evaluation of an SBIRT curriculum for emergency department providers, significant improvements in the providers’ self-reported confidence in ability and responsibility to intervene were noted.22The purpose of this study was to examine changes in residents’ attitude, experience, confidence, and readiness to implement SBIRT with patients. The study also elucidated the moderating effects on changes in attitudes, experiences, readiness, and confidence level of medical residents.     

Integrating Screening,Brief Intervention and Referral to Treatment (SBIRT) for Substance Use into Prenatal Care

Maternal and Child Health Journal - Universal screening for substance use during pregnancy, brief intervention, and referral to treatment (SBIRT) is recommended by ACOG and the USPSTF. Here we...     

Substance Use Screening,Brief Intervention,and Referral to Treatment Among Medicaid Patients in Wisconsin: Impacts on Healthcare Utilization and Costs

Unhealthy substance use in the USA results in significant mortality and morbidity. This study measured the effectiveness of paraprofessional-administered substance use screening, brief intervention, and referral to treatment (SBIRT) services on subsequent healthcare utilization and costs. The pre-post with comparison group study design used a population-based sample of Medicaid patients 18–64 years receiving healthcare services from 33 clinics in Wisconsin. Substance use screens were completed by 7367 Medicaid beneficiaries, who were compared to 6751 randomly selected treatment-as-usual Medicaid patients. Compared to unscreened patients, those screened changed their utilization over the 24-month follow-up period by 0.143 outpatient days per member per month (PMPM) (p?<?0.001), ?0.036 inpatient days PMPM (p?<?0.05), ?0.001 inpatient admissions PMPM (non-significant), and ?0.004 emergency department days PMPM (non-significant). The best estimate of net annual savings is $391 per Medicaid adult beneficiary (2014 dollars). SBIRT was associated with significantly greater outpatient visits and significant reductions in inpatient days among working-age Medicaid beneficiaries in Wisconsin.     

护理干预对脑卒中后抑郁的影响研究

目的探讨护理干预对脑卒中后抑郁（PSD）情绪的改善作用。方法选取2007年1月-2008年1月在我院住院的36例PSD患者进行护理干预,对比分析干预前后患者的情绪状况。结果干预前卒中患者抑郁症的发病率80．56％,干预后发病率27．78％,干预前后差异具有统计学意义（P〈0.005）;干预后第3周、干预后第6周与干预前比较,HAMD评分差异均具有统计学意义（分别有P〈0．001）。结论护理干预可以改善PSD患者的抑郁状态,促进患者的康复。     

护理干预对脑卒中后抑郁的影响研究

目的探讨护理干预对脑卒中后抑郁(PSD)情绪的改善作用。方法选取2007年1月～2008年1月在我院住院的36例PSD患者进行护理干预,对比分析干预前后患者的情绪状况。结果干预前卒中患者抑郁症的发病率80.56%,干预后发病率27.78%,干预前后差异具有统计学意义(P<0.005);干预后第3周、干预后第6周与干预前比较,HAMD评分差异均具有统计学意义(分别有P<0.001)。结论护理干预可以改善PSD患者的抑郁状态,促进患者的康复。     

早期心理干预对抑郁症康复的影响

目的探讨心理干预对抑郁症疗效的影响。方法将68例抑郁症患者随机分为观察组和对照组各34例,对照组进行常规治疗与护理,观察组在此基础上进行心理干预。进行为期8周的疗效观察。采用汉密顿抑郁量表（HAMD）和汉密顿焦虑量表（HAMA）临床疗效及住院护理观察量表（NOSIE）进行评定。结果观察组显效26例（76.47%）,显著高于对照组14例（41.18%）（χ2=8.74,P〈0.01）,HAMD、HAMA量表显示观察组与对照组在干预后的4、6、8周末比较,差异有统计学意义（P〈0.01）。NOSIE评定8周末时社会功能康复情况观察组也优于对照组（P〈0.05）。结论心理干预能明显提高抑郁症的疗效,有利于社会功能的康复。     

心理干预对产妇产后抑郁的临床效果观察

目的观察心理干预应用于产后抑郁患者的效果。方法选择2013年11月至2015年2月我院收治的产后抑郁患者150例,随机均分为干预组和对照组各75例。对照组采用常规护理,干预组在常规护理的基础上加用心理干预,比较两组的护理效果。结果干预组的护理满意度为96.0%,显著高于对照组的73.3%,差异具有显著统计学意义(P<0.01)。护理后干预组的SAS、SDS评分情况均显著优于对照组,差异具有显著统计学意义(P<0.01)。结论心理干预能有效地改善产后抑郁患者的心理状态,提高护理满意度,值得临床推广应用。     

Screening and Brief Intervention in the Management of Early Problem Drinkers

Despite the public health importance of alcohol misuse by early problem drinkers, treatment efforts for those with alcohol problems have focused largely on individuals with already established alcohol dependence. This article discusses screening tools commonly used to identify a variety of early problem drinkers, biological markers of heavy drinking and a framework by which to approach alcohol misuse. The results of 4 meta-analyses of brief intervention are also summarised. While all meta-analyses showed that some type of brief intervention decreased alcohol consumption for all, or a subset of, early problem drinkers, it is yet to be agreed as to what type of drinker can benefit from what type of brief intervention.The implementation of these research findings into clinical practice has been inconsistent as physicians often fail to identify alcohol problems in their patients. Compared with other chronic medical illnesses, physicians do not diagnose or treat addictive disorders with the same accuracy or effectiveness. Barriers to the implementation of screening and brief interventions by the physician include a lack of time and diagnostic skills, negative attitudes and the perception that diagnosing problem drinkers is not part of the physician’s role.As research determines which subgroups of drinkers are most likely to respond best to specific types of brief intervention, this approach is likely to gain a more stable and defined place in the behavioural healthcare system. Nonetheless, incorporating existing findings into the healthcare professional’s practice remains a challenge.     

The Cost of Screening and Brief Intervention in Employee Assistance Programs

Few studies examine the costs of conducting screening and brief intervention (SBI) in settings outside health care. This study addresses this gap in knowledge by examining the employer-incurred costs of SBI in an employee assistance program (EAP) when delivered by counselors. Screening was self-administered as part of the intake paperwork, and the brief intervention (BI) was delivered during a regular counseling session. Training costs were 83 per counselor. The cost of a screen to the employer was83 per counselor. The cost of a screen to the employer was 0.64; most of this cost comprised the cost of the time the client spent completing the screen. The cost of a BI was $2.52. The cost of SBI is lower than cost estimates of SBI conducted in a health care setting. The low costs for the current study suggest that only modest gains in outcomes would likely be needed to justify delivering SBI in an EAP setting.     

社区恶性肿瘤患者抑郁干预效果评价

摘要：目的了解抑郁干预对改善恶性肿瘤患者抑郁状况和提高生活质量的作用,为优化社区随访管理模式提供参考。方法采用类社区试验研究的方法,将干预社区筛选出来的抑郁患者54人（干预组）,在接受恶性肿瘤常规治疗同时,给予为期6个月的心理支持和放松干预、认知和行为干预、社会支持等抑郁干预;将对照社区筛选出的抑郁患者54人（对照组）,只接受常规治疗。干预前后对两组分别以Beck抑郁自评量表（BDI-13）和生活质量自评量表（FACT—G）进行评估并比较两组结果。结果干预组抑郁评分、抑郁状况、抑郁程度均较干预前及其对照组有明显改善,差别有显著性（P〈0．05）;干预组生理状况（PWB）、社会及家庭状况（SWB）、情感状况（EWB）和功能状况（FWB）各领域评分和生活质量总分干预后均有明显提高,差别有显著性（P〈0．05）,生活质量明显得到改善,与对照组比较差别也有显著意义（P〈0．05）。结论开展社区肿瘤患者心理支持和抑郁干预,对改善其抑郁状况,提高生活质量起到积极作用。     

Increasing Clinician Self-Efficacy for Screening and Counseling Adolescents for Risky Health Behaviors: Results of an Intervention

This study evaluates a training and tools intervention to increase provider self-efficacy to screen and counsel adolescents for risky behavior. Two clinics within a health maintenance organization served as intervention sites, and two as comparison sites. Self-efficacy to deliver adolescent services increased significantly in the intervention group relative to the comparison group.     

Development of a Brief Caregiver-centric Screening Tool to Identify Risk of Depression among Caregivers of Hospitalized Older Adults

The journal of nutrition, health & aging - Caregivers of hospitalized older adults experience elevated levels of stress and are at risk of poor health outcomes. There is a lack of screening...     

护理干预对咽异感症治疗效果的影响

目的探讨咽异感症的护理干预方法及治疗效果.方法?将2011年7月—2012年7月该院收治的咽异感症患者282例随机分为观察组141例(护理干预)与对照组141例(常规护理),对两组的治疗效果进行对比.结果?观察组的总有效率为89.36%(126/141),对照组的为73.76%(104/141),两组总有效率相比差异有统计学意义(P<0.05).结论?护理干预可以提高咽异感症的治疗效果.     

Comparison of Screening and Referral Strategies for Exposure to Partner Violence

BackgroundAlthough under debate, routine screening for intimate partner violence (IPV) is recommended in health care settings. This study explored the utility of different screening and referral strategies for women exposed to IPV in primary health care.MethodsUsing a randomized controlled trial design we compared two screening strategies (health care providers [HCP] versus audio computer-assisted self-interviews [A-CASI]) and three referral strategies (HCP alone, A-CASI referral with HCP endorsement, and A-CASI alone). English-speaking women who were 18 years and older and were attending women's health clinics at a public hospital were eligible to participate. Participants were randomly assigned to one of three study groups (HCP screen and referral, A-CASI screen and referral with HCP referral endorsement, and A-CASI screen and referral). Women were reinterviewed by telephone 1 week later. The primary outcome was rate of IPV disclosure; secondary outcomes were screening mode preference, reactions to IPV screening, and use of referral resources.ResultsOf the 129 eligible women, 126 women were enrolled (98%); 102 women (81% of those enrolled) completed the follow-up telephone interview. Disclosure rates were higher for women screened with A-CASI compared with HCP-screened women (21% vs. 9%; p = .07). Screening mode preference, impact of screening (positive and negative reactions), and rates of use of referral resources were similar between study groups.ConclusionA-CASI tended to yield higher rates of IPV disclosure and similar rates of use of referral resources. A-CASI technology may be a practical way to screen for IPV.     

Community-Engaged Research to Translate Developmental Screening and Referral Processes into Locally-Relevant,Family-Centered Language

Maternal and Child Health Journal - This project employed Boot Camp Translation (BCT) to engage community stakeholders in the translation of developmental screening guidelines and early...     

心理护理干预对脑卒中吞咽障碍并发抑郁患者的影响

目的探讨心理护理干预对脑卒中吞咽障碍并发抑郁患者的影响。方法选取2018年1月至2019年3月期间我院收治的脑卒中吞咽障碍并发抑郁患者120例,随机将其分为对照组和观察组各60例。对照组采用常规护理干预,观察组在对照组基础上采用心理护理干预。采用HAMD和SSQOL量表评价两组患者护理前后抑郁状态及生活质量状况,并观察两组患者的吞咽功能改善状况及护理满意度。结果护理前,两组患者的HAMD评分、 SSQOL评分比较无统计学差异(P>0.05);护理后,两组患者的HAMD评分均明显下降,SSQOL评分均明显提升,且观察组的HAMD评分、 SSQOL评分明显优于对照组(P均<0.05)。观察组的吞咽功能改善优良率为93.33%,明显高于对照组的78.33%(P <0.05)。观察组的护理满意度为95.00%,明显高于对照组的83.33%(P <0.05)。结论心理护理干预可有效改善脑卒中吞咽障碍并发抑郁患者的吞咽功能和抑郁症状,可提升其生活质量和护理满意度,对其康复具有积极影响,值得临床推广。