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Piloted Enhancements to a Screening, Brief Intervention, and Referral to Treatment Program in the FQHC Setting

CP18 - Piloted Enhancements to a Screening, Brief Intervention, and Referral to Treatment Program in the FQHC Setting

Poster Type: Innovation

Primary Funding Source: The piloted enhancements to the SBIRT workflow are currently funded by a five-year grant from SAMHSA (September 2018 - September 2023)

Category: Behavioral Health Services

Issue or Challenge: Access Community Health Network (ACCESS), one of the largest networks of federally qualified health centers in the nation, has sustained a universal Screening, Brief Intervention, and Referral to Treatment (SBIRT) program across all 35 of its Chicagoland health centers since 2015. Although medical assistants have consistently completed annual patient screenings for alcohol and drug use since the program launched, positivity rates were low compared to known rates in the general population. Furthermore, medical providers struggled to find time during the encounter to prioritize preventive interventions for patients that screen low, albeit positive, on alcohol and drug use screenings.

Description of Innovation: In 2019, ACCESS began to pilot an enhanced SBIRT program that embeds a designated SBIRT paraprofessional, or Community Health Specialist (CHS), at each of five pilot health centers. The CHS is integrated into the care team to screen patients for alcohol and substance use, conduct a brief intervention in the form of a motivational interview with patients with potentially risky use, and facilitate referrals to integrated behavioral health services, onsite medication-assisted recovery (MAR), and external treatment services, as appropriate.

Impact or Result: In the first two years of the pilot program, the ability to detect positive patients at SBIRT pilot sites greatly improved. ACCESS CHSs screened over 5,800 patients. Among patients that screened positive (19%), over half (55%) indicated marijuana use at least once in the past thirty days, and rates of daily marijuana use exceeded that of daily alcohol use (24% of positive-screened patients compared to 11%). CHSs consistently delivered motivational interviews to over 99% of patients identified for SBIRT services. In addition, a higher-than-expected number of SBIRT patients, including negative-screened patients, met with an ACCESS behavioral health consultant within six months of their initial CHS encounter.

Replicating this Innovation: ACCESS has only piloted the enhanced SBIRT workflow within our own organization. However, thorough evaluation of our SBIRT CHS training activities found important take-aways for other organizations interested in integrating similar roles into their care team. To prepare CHSs to deliver consistent and effective motivational interviews, we found that trainings must be spaced out gradually over multiple months to allow time for staff to test new concepts in the field between trainings. Effective training must also include both interactive group activities (role plays, peer feedback, analyzing videos), and individual coaching. Trainings at ACCESS were conducted by a member of the Motivational Interviewing Network of Trainers (MINT).

Author(s):

Amber Kraft, PhD, Evaluation Specialist, Access Community Health Network