Transcript PowerPoint Slides - What is SBIRT?

Webinar:
Innovations in Screening, Brief Intervention & Substance Use
Education for Health Professionals
February 25, 2015, 3-4pm ET
Agenda:
1) Challenges and best practices in conducting SBIRT (15 min)
2) Benefits of using virtual humans in the development and assessment of SBIRT (5 min)
3) Demo of At-Risk in Primary Care + Research results (15 min)
4) Overview of SAMHSA’s SBIRT RFA (5 min)
5) Q&A (10 min)
Dr. Eric Goplerud
SVP and Director
Public Health Department
NORC at the University of Chicago
Dr. Tracy McPherson
Senior Research Scientist
Public Health Department
NORC at the University of Chicago
Ron Goldman
Co-Founder & CEO
Kognito
SBIRT Implementation, Benefits, and Challenges:
Opportunities to Enhance Implementation and Training using Technology
Tracy L. McPherson, PhD
NORC at the University of Chicago
Presenter
Tracy L. McPherson, PhD
Senior Research Scientist
Public Health Research
NORC at the University of Chicago
National SBIRT ATTC
BIG SBIRT Initiative
Adolescent SBIRT SW & Nursing Learning Collaborative
[email protected]
[email protected]
Agenda
 Why SBIRT?
 Implementing SBIRT
 Challenges
 Hot spots
 Training Challenges, Opportunities, and Resources
 Conrad Hilton Adolescent SBIRT Project
Why SBIRT?
Substance use is a public health and safety issue.
Substance use has a profound impact on patients/clients and their families:
• Cause or exacerbate health conditions
• Poorly managed health conditions
• Reduce effectiveness of medications
• ER visits and excess hospital stays
• Accidents and damage
• Injuries and violence
• Lower productivity, lost work days
• Worker compensation , disability, worker turnover
• Financial and legal problems
• Family disruptions and relationship problems
• Sexual risk-taking
• Overdose and suicide
Why SBIRT?
SBIRT Provides a Framework for Addressing 3 of the 10 Leading Risk Factors for Disease In
Developed Countries
Tobacco
Blood pressure
Alcohol
Cholesterol
Overweight
Low fruit & Vege …
inactivity
Illicit drugs
Unsafe sex
Iron deficiency
0
5
10
Percent of disability-adjusted life years
Northwest ATTC iThur presentation: (2012) The World Health Report 2002
15
Why SBIRT?
 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 atrisk for developing them.
Why SBIRT?
Why SBIRT?
SBIRT Aims To:
• Increase early identification of patients/clients at-risk for SU problems.
• Build awareness and educate patients/clients on U.S. guidelines and risks
associated with SU.
• Motivate those at-risk to reduce unhealthy, risky SU; and adopt health
promoting behavior.
• Motivate individuals to seek help and increase access to care for those
with (or at risk for) a SUD.
• Foster a continuum of care by integrating prevention, intervention, and
treatment services.
At-risk drinking and
alcohol problems are
common
Alcohol and other drugs
significantly impact
patient and public health
SBIRT
SBIRT is proven to be
effective
Source – SBIRT Oregon Residency Program, 2012
Substance use is one of
America’s top preventable
health issues
Implementing SBIRT
SBIRT can be implemented in a range of settings:
• Primary care
• Federally Qualified Health Centers
• Trauma
• Drug Courts, Juvenile Justice
• Emergency Department
• Dental Clinics
• Hospital Inpatient
• HIV Clinics
• Employee Assistance Programs
• Colleges/Universities
• Health Promotion and Wellness Programs
• School-based Health Centers
• Occupational Health and Safety, Disability
Management
• Peer Assistance Programs
• Community Mental Health Centers
• Counseling/Therapy
• Addiction Treatment
• Health Professional Training Programs
Hot Spots of SBIRT Implementation
Hot Spot 1: Hospitals
Screening and Treating Acutely Ill and Injured Patients with Comorbid Substance
Use
Cochrane Collaboration review (McQueen et al, 2011)
14 RCTs, adults and adolescents
Outcomes favor BI over non-treatment controls
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Significant drop in 6 month alcohol consumption
Significant drop in alcohol consumption at 9 months
Self Report at 1 year favor BI
Significantly fewer deaths at 6 months and 1 year
Salina Regional Health
Center
Outcomes
• 199 Bed Acute Care Regional Health
Center-Level III Trauma Center
• 27,000 ED presentations per year
• Alcohol/Drug DRG was 2nd most
frequent re-admission
• Re-admission DRG moved from 2nd
to 13th.
Services provided
 24-7 coverage of ED
 Full time SUD staff on medical
and surgical floors
 Warm hand off provided to all
SUD/MH services
 Universal Screening and SBI
beginning in 2013
• 58% of patients recommended for
further intervention attended first
two appointments (warm hand off).
• 70% of alcohol/drug withdrawal
LOS were 3 days or less.
• 83% of SUD patients triaged in ED
were not admitted.
• Adverse patient and staff incidents
decreased by 60%.
• CKF detox admissions increased
450% in first year.
• 300% increase in commercial
insurance reimbursement.
Hot Spot 2: Prenatal Screening and Case Management
Kaiser –Permanente Northern California’s
Early Start Program
• Universal Screening of ALL pregnant
women
• Screening questionnaire
• Urine toxicology (with consent)
• Place a licensed mental health provider
in the department of OB/GYN
• Link the Early Start appointments with
routine prenatal care appointments
• Educate all women and providers
A transformational program that
is cost beneficial
Rate of Preterm Delivery (<37 Weeks)
17.4%
20.0%
15.0%
9.7%
10.0%
8.1%
6.8%
5.0%
0.0%
SAF
SA
S
Controls
Note: The rate of Preterm Delivery is 2.1 times higher in S group than SAF (Early Start patients)
Maternal and Infant Mean Costs Comparison
Positive Screen, No SA
Treatment
$30,000
$25,000
$20,000
$15,000
$10,000
$5,000
$0
SAF
Maternal Total Costs
SA
Infant Total Costs
S
Controls
Maternal and Infant Costs Combined
Hot Spot 3: Youth and Young Adult High Risk Users
Teen and Young Adult School Health and
Ambulatory Health SUD Treatment
• Data were pooled from 16,915 adolescents from
148 local CSAT-funded programs and followed
quarterly for 6 to 12 months.
• In 2009 dollars, adolescents averaged $3,908 in
costs to taxpayers in the 90 days before intake
($15,633 in the year before intake).
• This would be $3.9 Million per 1,000 adolescents
served.
• Within 12 months, the cost of treatment was offset
by reductions in other costs producing a net benefit
to taxpayers of $4,592 per adolescent.
Hot Spot Webcasts
• Kansas (Substance Use Treatment-Hospital Partnership)
http://hospitalsbirt.webs.com/partnershipsimplementing.htm
• Early Start Program at Kaiser (OB/GYN)
http://hospitalsbirt.webs.com/hospitalalcoholpregnancy.htm
Hear about other models:
• Gosnold on Cape Cod (Addiction Treatment-Hospital Partnership)
http://hospitalsbirt.webs.com/hospitalalcoholpregnancy.htm
• Southwest Virginia Community Health Systems (FQHC)
http://hospitalsbirt.webs.com/health-centers-sbirt
• Cook County (Criminal Justice)
http://hospitalsbirt.webs.com/criminaljusticesbirt.htm
Challenges of Implementing SBIRT
“We don’t have time. We already do 50 million things…. How can we do
one more?”
“We aren’t trained to address substance use and we don’t have the
resources to get our staff trained…We can’t take our staff offline.”
“Our patients have more pressing concerns than substance use. It’s
not that important compared to the other issues they face like
diabetes, heart disease, or depression.”
Challenges of Implementing SBIRT
• Scalability – its not a one size fits all
• Facility specific – it does boil down to how will it work at
each site
• Common barriers – design specific & site specific
• Training – all settings need initial and boosters, fidelity and
proficiency monitoring in all settings, with all types of
practitioners
Challenges of Implementing SBIRT
Common barriers
• Lack of awareness, skills, and knowledge about screening tools
• Discomfort initiating discussions about AOD use/misuse
• Belief of not having enough time to carry out interventions
• Uncertainty about referral resources
• Limited or lack of insurance company reimbursement
• Negative attitudes toward substance abusers
• Pessimism about the efficacy of treatment
• Fear of losing or alienating patients
• Lack of simple guidelines for brief intervention
• Lack of education and training about the nature of addiction or
to effectively screen and intervene
Overcoming Challenges – Prep, Prep, Prep
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Do a strengths assessment
Do a work flow analysis
Define target population
Develop clear practice guidelines
Develop a charting/documentation protocol
Develop a billing strategy
Develop a data collection, storage, and analysis plan
Develop a quality improvement initiative (fidelity/quality)
Establish a referral network
Develop a training plan (get buy-in before you train)
Identify technology to facilitate practice (EHRs, tablets, eSBI)
Identify technology to facilitate training (Interactive simulations, On- Demand courses/webinars)
Don’t recreate the wheel.
Identify and use resources and technology that enhance what you’re doing.
SBIRT Training
Face-to-face SBIRT training – Most common
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Often seen as the only or best way
Varies dramatically from a 1 hour didactic presentation to 2+ day workshop
Often a “one shot deal”
One shot deals don’t allow for real world practice and ongoing feedback, coaching, or booster
sessions
May not offer enough observational /vicarious learning
May offer few opportunities practice
May not offer sufficient feedback
Can be costly – to individuals or organizations
Often small training budgets limit the number of staff who can participate
Requires staff to be taken “off line”
May require staff to travel
Must be repeated due to staff turnover
SBIRT Training
Face-to-face training can be enhanced by other learning opportunities:
• Use of actors as standardized patients (can be expensive)
• On-Demand courses (often free /low cost; typically under-utilized/unknown)
• Live and recorded webinars - specific settings, populations, or general/ overview (often
free/low cost; typically under-utilized/unknown)
• Use of e-SBI platforms and tablet-based applications to learn, practice and facilitate SBI with
patients/clients (e.g., Radiant Interactive Behavioral Health Risk Assessment Check-up)
• Use of interactive web-based patient/client simulation technology – allows user to practice
competencies and receive feedback, provides boosters/refreshers, assesses skill acquisition
(new state of the art technology; typically under-utilized/unknown; e.g., Kognito and MedRespond
training)
National SBIRT ATTC – SBIRT Suite of Services
On-Demand Courses
• SBIRT 101 – Foundations Course
• SBIRT for Adolescents Course
To access courses go to: http://ireta.org/improve-practice/addiction-professionals/online-courses/
National SBIRT ATTC - Webinar Library
http://my.ireta.org/webinarlibrary-mobile
BIG Initiative – Live & On-Demand Webinars
http://hospitalsbirt.webs.com/webinars.htm
http://bigsbirteducation.webs.com/webinars.htm
BIG Initiative – Learner Guides
http://bigsbirteducation.webs.com/learnersguides.htm
Interactive Tablet-based SBIRT Tools
Radiant Interactive – BHRA Check-up
For more information/demo contact Radiant Interactive at [email protected]
Interactive Virtual Patient Simulations - Kognito
More to come on this…
Additional Resources
• SAMHSA-National Council CIHS http://www.integration.samhsa.gov/clinical-practice/sbirt
• National SBIRT ATTC http://sbirt.ireta.org/sbirt
• National ATTC Network www.attcnetwork.org
• Online course for docs - http://www.sbirttraining.com/
• Websites http://www.oasas.ny.gov/AdMed/sbirt/index.cfm
http://www.improvinghealthcolorado.org/
http://www.sbirtoregon.org/
http://medicine.yale.edu/sbirt/index.aspx
http://www.bu.edu/bniart/sbirt-experience/sbirt-programs/
http://www.attcelearn.org/
http://www.motivationalinterview.org/
Integrating Adolescent SBIRT in Social Work and Nursing School Education
• Conrad N. Hilton Adolescent SBIRT Grant – Launched October 2014 (3 year effort)
• Overall Aim: To collaborate with schools of social work and nursing and leading professional associations
to develop and test an interactive patient/client simulation training program, and to infuse adolescent
SBIRT education into existing social work and nursing curriculum.
• Collaborators: CSWE, CCSW, AACN, Kognito, and many others.
• Learning Collaborative: Open to Schools of Social Work and Nursing launched January 2015 (Join Now!)
• Visit our Website: http://sbirt.webs.com
• For More Info or to Join: Email Danielle Noriega at: [email protected]
Conversations are Powerful Tools to
Change Attitudes and Behaviors
Conversations are a social act of collaboration
Conversations are NOT:
- Instruction-giving
- Information delivery
- Speeches
- Talk that elicits no meaning
Conversations are an Integral Part of
Changing Health Behaviors
Individual/Environment:
Medical condition
Mindset
Concerns
Barriers to change
Intrinsic motivation to change
Individual
Environment
Behavior
Virtual Humans
“Virtual Humans
are automated agents that converse,
understand, reason and exhibit emotions.
They possess a three-dimensional body
and perform tasks through dialogs with
humans.”
Source: chatterbots.org
Benefits of Virtual Humans
Instructional Benefits:
 Safe to self-disclose, experiment
 Increase in engagement, openness
 Decrease in transference reactions
 Decrease in social evaluative threat
 The challenge of the uncanny valley
Other benefits:
 Personalization of experience
 Reduce costs of updates
 “Choose your Avatar” option
Level 1: Voice/Text Based
NextIT - SGT Star, Alme
Nuance - Nina
Apple Siri
Level 2: Animated + Voice
USC – SimCoach
UFL – Pediatrics & Low English Proficiency
Level 3: Emotionally Responsive
 3-D, fully animated
 Real-life behaviors
- Individual personalities
- Memory
- Emotionally responsive
 Adapt to players’ decisions
Be interviewed by the virtual human to identify their
own barriers to change and build motivation
Learn how to manage health
conversations with others
Demo
A 1-hour CNE & CME online simulation; structured as 10-15 min modules
Virtual Patients
Level 1:
Level 2:
Antoine, 38
Chief Complaint: Back pain, seeking prescription renewal for pain
medication
Underlying Issue: PTSD
Judith, 65
Chief Complaint: Arthritis
Underlying Issue: Depression following retirement and loss of
daughter on 9/11
Goals:
Determine risk of mental health disorder
Goals:
Discuss results of PHQ-9
Collaboratively develop treatment plan that integrates behavioral
health
Collaboratively develop treatment plan that integrates behavioral
health
Build motivation to treatment adherence
Build motivation to treatment adherence
Targeted Skills
Cognition
Mentalizing
Empathic Accuracy
…
Communication
Motivational Interviewing
Collaboration, Trust
Empathic Listening
Pacing Discussion
…
Skills + attitudes + confidence + motivation +
knowledge to apply and engage in real life
conversations to drive behavior change
Emotion
Emotional Self-Regulation
Emotional Regulation
Reappraisal Strategy
Empathy
…
Results: Primary Care Setting
Longitudinal Study with 516 Health Professionals in 6
States (N=87 matched pairs)
Goal of Simulation: Increase screening for depression and substance abuse within primary care
settings, integration of behavioral health, and treatment adherence by such patients
Method: Empowering physicians and nurses with the skills and motivation to engage in challenging
screening and brief intervention conversations with patients that exhibit signs of depression and
substance use disorders.
Participants: 19% physicians, 55% nurses, 8% Nurse Practitioners, 14% Medical Students, 7% Nursing Students,
26% male, 82% Caucasian, 12% Hispanic, 13% African American. 58% in NYC, 31% North Dakota, 11% in Arizona,
Oklahoma, Virginia.
Study Design: Participants completed pre-training, post-training, and a 3-month follow up surveys. Surveys asked
a range of Likert scale and open-ended questions to determine changes in skills, attitudes, and behavioral intent.
2015. Kognito. All Rights Reserved. Do Not Share without Kognito Approval
Results: Primary Care Setting
Quality of Learning Experience
• 94% reported that the simulation was well constructed and easy to use
• 79% reported that it was relevant to their patient population to a “great extent”
or “very great extent”
• 84% reported that the simulated conversations with virtual humans were helpful
to a “great extent” or “very great extent” in learning effective conversation tactics to
increase patient engagement, trust, and adherence to treatment plans
• 81% reported that the simulated conversations with virtual humans were, to a
“great extent” or “very great extent,” realistic representations of conversations they
have with their patients
Overall Satisfaction
• 84% said the simulation was at their skill level (16% said it was above their skill level)
• 95% reported that they will recommend it to their colleagues
Results: Primary Care Setting
Changes in knowledge and Skill
Study found statistically significant (p<.05) and sustainable increase at follow-up in learners’ knowledge and skill to:
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Identify risk factors and warning signs of mental health disorders
Screen patients for symptoms of a mental health disorder
Discuss treatment options
Engage in collaborative decision making about treatment plans
Build intrinsic motivation in patients to adhere to the suggested treatment plans
Behavior Change
At 3-month follow-up, as a result of taking the simulation:
• 62% reported increases in the number of patients they screened
• 57% reported increases in discussions with patients about treatment options
• 52% reported that they engaged more frequently in collaborative decision-making about treatment plans
Questions & Answers
Dr. Eric Goplerud
SVP and Director
Public Health Department
NORC at the University of Chicago
301-634-9525
[email protected]
Dr. Tracy McPherson
Senior Research Scientist
Public Health Department
NORC at the University of Chicago
Ron Goldman
Co-Founder & CEO
Kognito
757-427-1028
[email protected]
212-675-9234
[email protected]
Demos: www.kognito.com
Extra Slides
Approach: Immersive Learning Conversations
Science Driven and Research Proven
Neuroscience
`
Social Cognition
Adult Learning Theory
Virtual Humans with Real-Life Behaviors
Individual personalities Memory
Emotionally Responsive
Kognito’s Virtual Humans - Process
3-D Modeling
Behavior/Emotion Library
Kognito’s Virtual Humans - Process
Virtual Human Controller
Embedded in 3-D Environment