Vision and Leadership Advocacy

Provider PartnersTraining and Technical Assistance

4

GOALAdoption of SBIRT as a sustainable and universal practice for NH youth through:

• The expansion of youth SBIRT in primary care settings, • Addressing policy and financial barriers as identified, and • Screening no less than 10,000 patients ages 12-22 by 2017

An on-going process over time

Screening ToolsS2BIIn the past year, how many times have you used Tobacco? Alcohol? Marijuana?(STOP if all are “never.” Otherwise, continue with questions,) In the past year, how many times have you used:

• Prescription drugs that were not prescribed for you (such as pain medication or Adderall)?

• Illegal drugs (such as cocaine or Ecstasy)?• Inhalants (such as nitrous oxide)?• Herbs or synthetic drugs (such as salvia, “K2”, or

bath salts)?

CRAFFTC – Have you ever ridden in a CAR driven by someone (including yourself) who was “high” or had been using alcohol or drugs?

R – Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?

A – Do you ever use alcohol or drugs while you are by yourself, or ALONE?

F – Do you ever FORGET things you did while using alcohol or drugs?

F – Do your FAMILY or FRIENDS ever tell you that you should cut down on your drinking or drug use?

T – Have you ever gotten into TROUBLE while you were using alcohol or drugs?

*These questions are included for informational purposes only. They are not full screening tools.

Brief Intervention• A brief intervention (BI) is a

short, motivatingconversation in response to screening results – typically 3-7 minutes.

• BI utilizes motivational interviewing techniques, you do not need to be an expert – primarily being done by primary care providers.

• BI is patient-centered – your goal is dependent on each patient’s circumstances and preferences – change is a process over time.

• The patient has the bestidea in the room – listen.

• Ideally a series of conversations over time.

Referral to TreatmentNew Hampshire Alcohol and Drug Treatment Locatorwww.nhtreatment.org

Follow Up• Closing the loop on screening results, brief intervention

conversation, or referral to further evaluation and treatment is crucial to on-going, whole health management with each patient

• Essential to your relationship with your patients and your establishment of alcohol and drug use information as integral to healthcare.

• Confidentiality of your brief intervention conversation with young patients may make scheduling face-to-face follow up more complex – how will you code the reason for a follow-up visit and explain it to the parent of the youth?

• Follow up by telephone or text communication, with signed informed consent, by behavioral health or case management staff may be an option at your site.

Implementation: Quality Planning and Support

Action Learning Collaborative

• Ten organizations in three cohorts

• Monthly group calls• Bi-annual meetings• Cross-site learning

• Resource development• Onsite individualized

quality planning and implementation assistance

• On-site tailored training

Training and Technical Assistance• Action Learning Collaborative • Webinars• Teleconferences• Training• Consultation• Facilitation• Presentations• Annual Statewide Summit• Playbook• www.sbirtnh.org

SBIRTNH.ORG

Implementation Checklist

Implementation Success Factors

• Team and Quality Improvement• Patient Confidentiality• Flow• Electronic Health Records• Billing and Coding• Training and On-Going Support

Team• Buy in from key leadership• Representation across disciplines and clinical flow• Meet regularly for learning and decision making

Perceived barrier

Actual barrier

Flow Decision - MakingA few screening related decisions…o What is the mechanism for screening? Verbal, paper,

electronic?o With whom, when, where does screen physical

occur?o How, why, by whom is screen documented?o How is next step determined? Positive

reinforcement, brief intervention, referral to further assessment, follow up???

Flow Role of the primary care provider• Crucial to flow of process• Ideally conducts BI• Creates environment to address alcohol and

drug use as a health issue• Follows up• Screens across lifespan

Example of Site Flow

Site EHR Example

Outcomes

Distribution of Screening Results

5%

11%

84%

16%

In NH, of all screened (n=13,044)

Aggregate numbers through Q1 2017

Seen/Visits = 17,196

Screened = 13,044 (76%)

Positive Screen = 2,031 (16%)

Received BI = 856 (7%)

Need Referral = 624 (5%)

Referred = 184 (1%)

Initiatives Target Population Sites FundersNH Youth SBIRT Initiative

Youth and Young Adults(ages 12-22)

10 grantee organizations x 24 sites: • Primary Care Clinics• Pediatric Practices• Family Medicine Practices• FQHCs

NH Charitable Foundation and Conrad N. Hilton Foundation

Pregnant women of all ages

OB/GYN

Community Health Centers

Adults (ages 18-65); Pregnant women

15 organizationsNH Bureau of Drug and Alcohol Services

NH AHEC Health professions students: • MD, Mental Health

Counseling, Nursing, PA, Pharmacy

5 institutions: • Antioch College• Franklin Pierce University• Geisel School of Medicine/Dartmouth• University of NH• Mass College of Pharmacy and Health Sciences

SAMHSA

Behavioral Health System Transformation

• 12 years and older • Primary Care, Behavioral Health, Community-based organizations Medicaid 1115

Waiver

JuvenileDiversion Network

• 12 years and older • 15 Juvenile Diversion programsNH Bureau of Drug and Alcohol Services

Can We Talk?Regular visits with doctors can keep teens

off drugs and alcohol

THANK YOUConrad N. Hilton Foundation and NH Charitable Foundation for supporting this important work.

Amy Pepin, LICSW, CPS apepin@jsi.com 603-573-3338

www.sbirtnh.org www.jsi.com