Sandeep Kapoor, MDDirector, SBIRT

Assistant Professor of MedicineHofstra North Shore-LIJ School of Medicine

SBIRT at NSLIJNew York Screening, Brief Intervention, and Referral to Treatment

(NYSBIRT-II)

North Shore-Long Island Jewish Health SystemDepartment of Emergency Medicine Division of General Internal Medicine

Department of Psychiatry & Behavioral Health

Dr. Kapoor have no conflicts of interest to report.

Sponsored by the NYS Council for Community Behavioral

Healthcareand the

National Council for Behavioral Health

NYSBIRT-II

Collaborative TeamDepartment of Emergency Medicine Division of General Internal Medicine

Department of Psychiatry & Behavioral Health

SAMHSA (Substance Abuse and Mental Health

Services Administration)Service Grant Sponsor

OASAS (NYS Office of Alcoholism and Substance

Abuse Services)Service Grant Administrator

CASAColumbia and NSLIJService Grant Partners

Training, Technical Assistance, Grant Evaluators - CASAOperations and Clinical Services - NSLIJ

Internal Medicine 865 Northern Blvd

LIJ – ACU2001 Marcus Ave

Staten Island North - MAP

Emergency Medicine Southside ED

SIUH - South EDSIUH - North ED

Lenox Health Greenwich Village

NSLIJ SBIRT Sandeep Kapoor, MD Director, NSLIJ SBIRT Nancy Kwon, MD, MPA Principal Investigator – Emergency Medicine

Joseph Conigliaro, MD, MPH Principal Investigator – Internal Medicine

Jon Morgenstern, PhD Principal Investigator – Psychiatry

NSLIJ Department of Medicine Thomas McGinn, MD, MPH Chairman, Medicine

Jeanne Morley, MD SBIRT MD Champion – Internal Medicine

Lauren McCullagh, MPH Administrative Director - Research

NSLIJ Department of Emergency Medicine John D’Angelo, MD Chairman, Emergency Medicine

Mark Auerbach, MD, MBA SBIRT MD Champion

Mae Ward, RN Administrative Director – Research

Karen Kline Senior Administrative Director II

NSLIJ Department of Psychiatry John Kane, MD Chairman, Psychiatry

Bruce Goldman, LCSW The Zucker Hillside Hospital

Daniel Coletti, PhD The Zucker Hillside Hospital

The National Center for Addiction and Substance Abuse at Columbia University (CASAColumbia)

Charlie Neighbors, PhDDirector

Megan O’Grady, PhD Associate Director

New York State Office of Alcoholism and Substance Abuse Services (OASAS)

Connie Burke NYSBIRT Project Director

Peggy Bonneau Director of Health Initiatives

Leadership

Completed PreScreens

PreScreen Positive

Brief Interventions

Referralsto Treatment

Southside ED (20 months) 23,490 14% 1143 295

SIUH South ED (15 months) 8,850 10% 417 68

SIUH North ED (15 months) 18,650 9% 573 87

Lenox Health GV (12 months) 5,264 24% 512 166

Services Delivered*During SBIRT Health Coach Hours*

 Dec2013-July2015

 

Primary Care + Emergency Medicine (20 months)

104,357 11% 3708 729

Who?What?

Where?When?Why?

Understanding the Importance

How many people are at risk?

• More than 1/2 of Americans age 12+ years are current drinkers– An estimated 58.6 million people (23.1% of general population) recently

engaged in a heavy drinking episode– 16.9 million reported a heavy drinking episodes on ≥ 5 days in the past

month – An estimated 18.7 million Americans drink alcohol in ways that are

potentially unhealthy

• 20.5 Million people need, but do not receive treatment for illicit drug or alcohol use

• Major source of referrals to treatment are NOT healthcare providers (only 6.6%), though most people see a doctor at least one time per year

Reference: SAMHSA (2011). 2010 National Survey on Drug Use and Health

Survey on Patient Attitudes

Agree/Strongly Agree

“If my doctor asked me how much I drink, I would give an honest answer.”

92%

“If my drinking is affecting my health, my doctor should advise me to cut down on alcohol.”

96%

“As part of my medical care, my doctor should feel free to ask me how much alcohol I drink.”

93%

Disagree/Strongly Disagree

“I would be annoyed if my doctor asked me how much alcohol I drink.”

86%

“I would be embarrassed if my doctor asked me how much alcohol I drink.”

78%

Patients Are Open To Discussing Their Substance Use

Source: Miller, P. M., et al. (2006). Alcohol & Alcoholism.Adapted from The Oregon SBIRT Primary Care Residency Initiative training curriculum

(www.sbirtoregon.org)

Who?What?

Where?When?Why?

Understanding the Importance

The SBIRT Process

SBIRT Components

Pre-ScreeningBrief strategy to identify at-risk population using a valid, brief standardized questionnaire at the initial point of service

< 1 minute

Full ScreeningValid extended standardized questionnaire administered with patient if they qualify based on the prescreen scores

< 3 minutes

Brief Intervention

One or more discussions with health care professional focused on reducing or stopping unhealthy substance use:

1. Assessment & feedback on substance use2. Simple advice, goal setting, agree on plan

10-20 minutes

Referral to Specialty Treatment

Based on extent of substance use/abuse, patients may require more than a brief intervention

Every effort is made, in real-time, to provide a ‘warm handoff’ to community treatment providers and those within the NSLIJ Health System.

Pre-Screening Questions: Alcohol, Drugs, Tobacco

1. How often do you have a drink containing alcohol? Never Monthly or less 2-4 times a month 2-3 times a week 4 or more times a week

2. How many standard drinks containing alcohol do you have on a typical (drinking) day?

1 or 2 3 or 4 5 or 6 7 to 9 10 or more

3. How often do you have 6 or more drinks on one occasion?

Never Less than monthly Monthly Weekly Daily or almost daily

4. In the past 12 months have you used drugs other than those required for medical reasons?

Yes No

5. In the past year, how often have you used tobacco products? Never Once or twice Monthly Weekly Daily or almost daily

Who?What?

Where?When?Why?

By January 2015, eight sites (in Long Island, Staten Island, and Manhattan) will provide SBIRT services.

As there are 18 Hospitals and nearly 400 points of entry within NSLIJHS, SBIRT service implementation

system wide will speak volumes.

Emergency Department

Internal Medicine Clinic

NSLIJ Sites for SBIRT Services

Patient enters the Emergency

Room

Patient is pre-screened by RNs after vital signs

Responses from pre-screen are documented

into EMR *Positive screen will elicit

an ICON to the Health Coach.

Health Coach will perform full screen and provide brief intervention for

positive full screens

Health Coach will discuss case with

treating Physician/Nurse

Health coach will work with clinical

team members and PATIENT to secure a

referral to treatment if needed

ED SBIRT Workflow

Who?What?

Where?When?Why?

Understanding the Importance

Making the Connection

Similar to preventative screenings for chronic diseases (ie. diabetes and hypertension)

Risky use

SBIRT allows us to NORMALIZE the discussionand treat substance use as the healthcare issue it is

Heart DiseaseHypertension

GastritisSleep

DepressionCancers

STDs Fetal alcohol spectrum

disorders

Substance Use Continuum

Rethinking Substance Use Problems From a Public Health Perspective

Programmatic

Service Delivery

“The road to success is

paved by challenges”

Referral To Treatment

Let your passion motivate others…

Allow their passion to motivate sustainability…

TrainingImplementationService DeliveryYear One Completed

What’s Next?

Refresh/Revisit all TrainingElicit Feedback on ImplementationExamine Fidelity of Service Delivery

What’s Next?

Engage… Engage… ENGAGEAllow their passion to motivate sustainability…

Questions?

THANK YOU!For more information

SBIRTinfo@nshs.edu