Integrating Adolescent Substance Use Screening, Brief Intervention, and Referral 

to Treatment (SBIRT) in Pediatric Healthcare Settings

©2018

No Conflict of interest to report©2018

Presenters

Tracy L. McPherson, PhDSenior Research Scientist, Public HealthNORC at the University of Chicago mcpherson-tracy@norc.org

Cyrille Adam, EdMSenior Director, Health ProgramsKognitocyrille@kognito.com

Anne Derouin, DNP, APRN, CPNP, FAANPAssociate Professor, PNP-PC ProgramDuke University School of Nursing Anne.derouin@duke.edu

Objectives

Discuss the SBIRT model, rationale and evidence for implementing SBIRT to address adolescent substance use.

Describe the components of the Adolescent SBIRT Toolkit for Pediatric nurse practitioners.

Discuss the benefits of using virtual patient simulation training in the development of SBIRT skills and assessment of SBIRT competencies for APRNs.

Describe the experience of nursing professionals utilizing the toolkit and virtual patient simulation program to develop SBIRT skills.

©2018

“Integrating Adolescent SBIRT into Social Work and Nursing Education Project”

Launched in September 2014 Steering Committee of 38+ subject matter

experts, researchers, educators, behavioral health organizations, and professional associations

Learning Collaborative of 70+ nursing, social work, and inter-professional school/programs

304 educators, field instructors and supervisors, preceptors, and practitioners

sbirt.webs.comhttp://sbirt.webs.com/learning-collaborative

©2018

What is SBIRT?

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a comprehensive, integrated, public health approach to the delivery of early intervention and treatment services for people with substance use disorders and those at-risk for developing them.

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Why SBIRT?

SBIRT Aims To: Increase early identification of youth at-risk for substance use problems.

Build awareness and educate youth on drinking guidelines and risks associated with substance use.

Motivate youth at-risk to reduce unhealthy, risky substance use; and adopt health promoting behavior.

Motivate youth to seek help and increase access to care for those with (or at risk for) a substance use disorder.

Foster a continuum of care by integrating prevention, intervention, and treatment services.

Addressing substance use as part of addressing the whole health of young people.

©2018

Why SBIRT?

Substance use is a public health and safety

issue and has a profound impact on youth and

their families

Assessment of decreased school performance

Chronic or poorly managed health conditions

Reduced effectiveness of medications

Increased ER visits and excess hospital stays

Overdose and suicide risks

Sexual risk-taking and trafficking

ACE’s concerns and lifelong impact:

Injuries and violence Early death Chronic conditions Lower productivity, lost work

days Life long financeal and legal

problems Family disruptions and

relationship problems

Impetus for the SBIRT Project

SBIRT is endorsed by leading professional associations/government agencies:

American Academy of Pediatrics (AAP) Policy Statement – July 2016!

American Medical Association (AMA)

Substance Abuse and Mental Health Services Administration (SAMHSA)

Center for Medicare and Medicaid Services (CMS)

National Institute on Alcohol Abuse and Alcoholism (NIAAA)

Support from nursing professional associations (e.g., IntNSA, AACN)

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Why students, nurses and PNPs?

Barriers By addressing other key barriers, we aim to overcome “time”

as a barrier. Lack of Training in Curriculum Lack of Curriculum Materials

Supplying Adolescent SBIRT Curriculum and toolkit was designed to effectively introduce SBIRT education and training.

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Adolescent SBIRT Curriculum

https://sbirt.webs.com/curriculum

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Adolescent SBIRT Learner’s Guide

Comprehensive introduction to SBIRT for adolescents and young adults

Examines each component of SBIRT and motivational interviewing skills

Sample pre/post evaluation measures

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Learner’s Guide Modules

Module 1 What is SBIRT for Youth and Why Use it?

Module 2 Screening

Module 3 Brief Intervention

Module 4 Referral to Treatment and Follow-up

Module 5 Motivational Interviewing Strategies

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Each module includes: Comprehensive Education

and Training Content Learning Objectives Suggested Readings Sample Conversations

and Dialogue Role Play Activities

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Online Resources and Materials

https://sbirt.webs.com/resources©2018

Screening Tools

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Case Studies and Role Plays

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Fact Sheets

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Learn More About The Toolkit

SBIRT for Youth Learning Community: Adolescent SBIRT Toolkit (on-demand): http://my.ireta.org/node/1173

©2018

Integrating SBIRT Project by the Numbers!

1,000 Instructor’s Toolkit requests

6,400+ completed Kognito simulation

10,000+ received education/training

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Learn the basics of screening and brief intervention and practice in 3 virtual conversationsAssume the role of a nurse or social worker and engage in virtual conversations

Control the conversation by choosing what to say

Receive feedback throughout that highlights important lessons and key strategies, including performance dashboard

How it Works

Demo

1. Learners construct meaning and knowledge from their experiences: do vs. tell

2. Trial and Error: what happens if…?3. Safe practice environment4. Private practice environment5. Modular / scaffolded 6. Ongoing feedback and reflection7. Competency assessment (not just knowledge)8. Transfer to similar but different situation9. Continuing Education: 2.0 ANCC CNE, 2.0 NASW, 2.0 

CME AMA PRA Category 1 Credits

Why Simulations?

Using the Simulation

www.kognitocampus.com

Create an Account

Each group will receive their own unique enrollment key. This will allow access to the simulation.

You will need to share this enrollment key with your users for them to gain access to the simulation.

Launch the Simulation

All simulations availableare shown

Details about the currentlyselected simulation

Once selected, launch the simulation

1. Introduction – General info on adolescents substance use & SBIRT2. Screening – Assessing substance use with validated tools3. Brief Intervention – Brief Negotiated Interview, MI4. Practice Conversations (Josh, Emily)5. Assessment Conversation (Kayla)

SBI with Adolescents will help individuals learn to:

1. Screen adolescents using evidence‐based tools

2. Conduct brief interventions using motivational interviewing techniques

3. Make collaborative action planswith adolescents

4. Refer adolescents to                treatment services

Virtual Conversations

Practice Conversations

Setting: Hospital ED

Condition: Ankle ligament injury

Remarks: Jumped off roof into hot tub

Screening Results: High‐risk/weekly use alcohol

Setting: School nurse/social worker office

Condition: Decreased attention

Remarks: Referred by teacher

Screening Results: High risk/weekly use marijuana

Josh Emily

Assessment Conversation

• Setting: Primary care• Condition: Annual well visit• Remarks: None• Screening results: Moderate risk/weekly use alcohol

Assessment features:

• No undo button• No inner thoughts• No BI checklist

• Total score• BI adherence score• MI adherence score

Kayla

Scoring & Analytics Scoring & Analytics

CPNP’s and students benefit from these tools• Creating habits that can be used in

clinical setting routinely• Confidence!• Use of tools that are effective in

screening • MI skills which promote positive

change (useful in any setting)• Ongoing resources and innovation• A community of referrals

Experience of PNP learners• Positive learning environment and experience

• Repetition was valuable in the process

• Increase demonstration of confidence

• Increase skills demonstrated with Standardized patients

• Increased confidence and skills which translated to the clinical setting• Graduate and DNP projects• Mentoring and role modeling for IPE peers• Natural “fit” for specialty settings for kids with

chronic conditions

Introduction

Practice

Integration

Questions about SBIRT and Kognito?

Tracy L. McPherson, PhDSenior Research Scientist, Public HealthNORC at the University of Chicago mcpherson-tracy@norc.org

Cyrille Adam, EdMSenior Director, Health ProgramsKognitocyrille@kognito.com