Transcript BRITE - TrustedPartner

SBIRT: Screening,
Brief Intervention,
Referral to Treatment
Stephen Ferrante, M.S.W.
Group Victory Managing Partner
Barry University School of Social Work Professor
[email protected]
954-249-2323
September 27, 2013
Substance Abuse Severity and Level of Care
Adapted from the SAMHSA TIP #34 (1999) and Institute of Medicine (1990)
None
Mild
Moderate
Severe
Specialized
Treatment
Brief
Intervention
Primary
Prevention
SBIRT Core Components
SBIRT Approach
National Evidence-based Initiative for Screening,
Brief Intervention, and Referral to Treatment
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Engagement
Pre-Screening: Risk Identification
Screening & Assessment: Risk Intensity
Appropriate Intervention: Brief Intervention /
Brief Treatment / Outpatient Treatment /
Inpatient Care / Referral Ancillary Services
• Discharge with Outcome Screening
• Follow-up Screens
SBIRT Process
• Universal Prescreening
– Symptoms Identification Difficult
– Minimal Self-Referral
• Full Assessment for Positive Prescreen
• Level of Risk dictates Service Type:
– Screening & Feedback (SF) for negative screens
– Brief Intervention (BI) for moderate risk
– Brief Treatment (BT) for moderate to high risk
– Referral to Treatment (RT) - high risk/problem use
Prescreen: Part I
Prescreen: Part II
Alcohol, Smoking, Substance Involvement Screening Test
(ASSIST)
World Health Organization (WHO)
• Interview Style Screen Administered for Positive
Prescreen
• ASSIST developed to help healthcare professionals
detect and manage substance use
• Scores provide a “level of risk” for substance misuse
and type of service that follows:
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Low risk = Screening & Feedback about results
Moderate risk = indicates the need for Brief Intervention
Moderate to High Risk = Brief Treatment
High Risk = Referral to Treatment
Motivational Interviewing
Therapeutic Alliance
• People who “Screen Positive” for Substance Misuse
– May be reluctant to seek help
– May be ambivalent about decision to change behavior
• Confrontation & Labeling may Produce “Resistance”
and/or “in Denial”
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Avoiding Labeling & Confrontation
Roll with Resistance
Enhance Self-Efficacy
Build Confidence in One’s Coping Strategies
Motivational Interviewing
• Acknowledging Motivation, Readiness & Ability for
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Change
Meeting Individuals Where They are
Respectful Listening
Accepting Individual’s Perspective
Identifying Consequences of Problem
Facilitating Perception Shift on Impact of Problem
Empowering Individual to Generate Insights &
Solutions
Expressing Belief in Person’s Capacity to Change
Offsetting Denial, Resentment & Shame
Early SBIRT Examples
• Emergency Departments
– Bernstein E, Bernstein J, Levenson S: Project ASSERT: An
ED-based intervention to increase access to primary care,
preventive services, and the substance abuse treatment
system. Ann Emerg Med , 1997; 30:181-189.
• Primary Care Practices as “Brief Physician
Advice”
– Fleming, MF., Manwell, LB, Barry, KL, Adams, W, &
Stauffacher, EA Brief physician advice for alcohol problems
in older adults: A randomized community-based trial. J Fam
Pract; 1999 48(5): 378-84
SBIRT Today
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Emergency Departments
Hospital Units
Primary Care Practices
Urgent Care
Federally Qualified Health Center
Health & Behavioral Health Clinic
Addiction Facilities
Educational Institutions
Community Service Settings
Health Care Providers can Provide
SBIRT Services under Medicare
• Medicare pays for medically reasonable & necessary
SBIRT services in physicians’ offices & outpatient hospitals
• Physicians, Physician Assistants, Nurse Practitioners,
Clinical Nurse Specialists, Clinical Psychologists, or
Clinical Social Workers can bill for SBIRT
• To bill Medicare, providers of MH services must be:
– Licensed or certified to perform mental health services
by the state in which they perform the services;
– Qualified to perform the specific mental health services
rendered; and
– Working within their State Scope of Practice Act
http://www.cms.gov/Outreach-and-Education/Medicare-Learning-NetworkMLN/MLNProducts/Downloads/SBIRT_Factsheet_ICN904084.pdf
SBIRT Billing & Reimbursement
• Affordable Care Act Recommended
Service
• Screening & Brief Intervention
Reimbursement
– Commercial insurance CPT codes
– Medicare G codes
– Medicaid HCPCS codes
• Florida has not approved Medicaid Billing
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Codes
SAMHSA Block & SBIRT Grants
SBIRT Coding
Payer
Commercial
Insurance
Code
CPT
99408
CPT
99409
Medicare
G0396
G0397
Medicaid
H0049
H0050
http://sbirt.samhsa.gov/coding.htm
Description
Alcohol and/or substance abuse
structured screening and brief
intervention services; 15 to 30 minutes
Alcohol and/or substance abuse
structured screening and brief
intervention services; greater than 30
minutes
Alcohol and/or substance abuse
structured screening and brief
intervention services; 15 to 30 minutes
Alcohol and/or substance abuse
structured screening and brief
intervention services; greater than 30
minutes
Alcohol and/or drug screening
Alcohol and/or drug service, brief
intervention, per 15 minutes
Fee
Schedule
$33.41
$65.51
$29.42
$57.69
$24.00
$48.00
Common Behavioral Health Codes
CPT Code
Description
90801
Diagnostic interview
90804
Individual psychotherapy, 20‒30 minutes
90806
Individual psychotherapy, 45‒50 minutes
http://sbirt.samhsa.gov/about.htm
The Result:
A 16-session
curriculum manual
for conducting brief
treatment
(Dupree & Schonfeld, CSAT,
2005)
http://kap.samhsa.gov/products/manuals/pdfs/substanceabuserelapse.pdf
Questions
Answers
Comments
Thank You!