CP15 - Successfully Integrating Substance Abuse Screening Practices into Primary Care to Increase Prevention, Early Intervention, and Treatment Services Among FQHC Patients

Poster Type: Innovation

Primary Funding Source: SAMHSA

Category: Behavioral Health Services

Issue or Challenge: As Federally Qualified Health Centers (FQHCs) transition from volume-based to value-based healthcare, FQHCs will benefit by earlier identification of patients who are at risk for substance use disorders (SUDs). Too often, SUD screening is not routine. Rather, screening is triggered only after patient referral to Behavioral Health (BH). This model of care supports treatment goals but misses prevention and early intervention opportunities that can mitigate need for more costly levels of care. To address this issue Health Quality Partners (HQP) launched a five-year, grant-funded initiative for systematically expanding SUD screening and treatment services through primary care integration at five FQHCs.

Description of Innovation: In late 2018, Substance Abuse and Mental Health Services Administration (SAMHSA) awarded HQP with a five-year Screening, Brief Intervention, and Referral to Treatment (SBIRT) grant for expanding SBIRT services and delivery capacity among five subcontractor FQHCs. Upon award notification, HQP launched an ongoing series of calls, monthly meetings, site visits, and other communications to assess and address capacity issues and other challenges unique to each FQHC. HQP worked with multiple departments at each FQHC to develop innovative solutions to challenges related to data collection, documentation, and transmittal, patient consent, workflow, inconsistent use of screening tools and scoring results, and staffing issues. During the project’s first year, many of these issues have been successfully addressed. All have implemented or are working toward systematic and universal pre-screening practices and administering the same evidence-based full-screening tools (i.e., AUDIT and DAST-10). Each FQHC’s primary care department has established screening policies and protocols and works closely with their BH department to coordinate care. Healthcare staff report that systematic and universal pre-screening practices in primary care is helping to destigmatize and normalize SUD screening inquiries and is increasing the number of patients they are referring to BH for treatment.

Impact or Result: Over a five-year period, this initiative will provide expanded SBIRT services to more than 100,000 patients. To date, all five FQHCs have implemented or expanded SBIRT services and engaged in the following activities: developed integrative SBIRT workflows appropriate for use in primary care settings; instituted policies and protocols for pre- and full-screening patients and systematically documenting results in their electronic health records; developed warm-handoff procedures to BH for patients with positive full-screen results; and integrated GPRA data collection protocols into their workflow. During the first full year of data collection, more than 13,000 primary care patients were pre-screened for SUDs and 416 completed full-screen assessments. A total of 263 patients received SBIRT treatment for mild to severe SUDs, i.e., Brief Intervention (34 percent), Brief Treatment (23 percent), or a Referral to Treatment (43 percent). Twenty-three providers also attended HQP’s Buprenorphine Waiver Training enabling expanded MAT services capacity at their FQHCs.

Replicating this Innovation: HQP plans to support its network of member health centers in expanding SBIRT services. HQP compiles an annual process and outcome report that evaluates programmatic objectives and documents best practices and lessons learned from SOS project staff, including resolving workflow issues and increasing staff engagement across departments. These reports are disseminated to key stakeholders through in-person presentations, quarterly newsletters, and key indicator dashboards.

Author(s):

Laura Stanley, PhD, Program Evaluator, Health Quality Partners