1 co-occurring disorders conference september 29, 2006 washington state screening, brief...

1Co-Occurring Disorders Conference September 29, 2006

WaWashington Stateshington StateSScreening, creening, BBrief rief IIntervention,ntervention,

RReferral, and eferral, and TTreatment Projectreatment Project

Stephen H. O’Neil, MA, CCDC IIIStephen H. O’Neil, MA, CCDC IIIWashington State Division of Alcohol and Substance AbuseWashington State Division of Alcohol and Substance Abuse

Co-Occurring Disorders Co-Occurring Disorders ConferenceConference

Expanding the Continuum – Expanding the Continuum – Improving CareImproving Care


WASBIRT OverviewWASBIRT Overview Nine of Washington’s busiest trauma Nine of Washington’s busiest trauma

hospitals, located in six separate counties, hospitals, located in six separate counties, are hosting 30 Chemical Dependency are hosting 30 Chemical Dependency Professionals (CDPs) inProfessionals (CDPs) intheir Emergency Departments (EDs). These their Emergency Departments (EDs). These professionals provide screening, brief professionals provide screening, brief intervention, and referral for those who need intervention, and referral for those who need a higher level of care.a higher level of care.

Brief therapists located in 11 community Brief therapists located in 11 community agencies provide a link to community agencies provide a link to community services.services.


Why SBIRTWhy SBIRT

Prior studies have shown that Prior studies have shown that interventions, when delivered to interventions, when delivered to injured patients in hospital emergency injured patients in hospital emergency departments and on hospital inpatient departments and on hospital inpatient units can:units can:

- Reduce alcohol and/or other drug use;Reduce alcohol and/or other drug use;- Prevent re-injury; and,Prevent re-injury; and,- Help patients with more severe problems Help patients with more severe problems

access intensive, community based access intensive, community based chemical dependency services.chemical dependency services.


WASBIRT ServicesWASBIRT Services Screening OnlyScreening Only – Patient screened for – Patient screened for

alcohol and/or other drug use; brief alcohol and/or other drug use; brief intervention not given.intervention not given.

Brief InterventionBrief Intervention – Patients screened for – Patients screened for alcohol and/or other drug use and receive a alcohol and/or other drug use and receive a Brief Intervention in the Hospital.Brief Intervention in the Hospital.

Brief TherapyBrief Therapy – Patient receive a Brief – Patient receive a Brief Intervention in the hospital plus community Intervention in the hospital plus community based Brief Therapy sessions.based Brief Therapy sessions.

CD TreatmentCD Treatment – Patient receive a Brief – Patient receive a Brief Intervention in the hospital plus traditional Intervention in the hospital plus traditional chemical dependency treatment. chemical dependency treatment.


WASBIRT PerformanceWASBIRT Performance

Between April 2004 and July 2006 Between April 2004 and July 2006 47,809 screenings have been 47,809 screenings have been conducted:conducted:

22,912 screen only (48%)22,912 screen only (48%) 23,190 screen and brief intervention (49%) 23,190 screen and brief intervention (49%) 1,707 have engaged in additional services 1,707 have engaged in additional services

(4%)(4%)


WASBIRT StructureWASBIRT Structure All patients aged 18 and over who present All patients aged 18 and over who present

in the emergency department are eligible in the emergency department are eligible to be screened with the following to be screened with the following exclusions:exclusions: Unconscious or otherwise unable to consent Unconscious or otherwise unable to consent

(intoxication, psychosis, extreme trauma)(intoxication, psychosis, extreme trauma) In police custodyIn police custody

Patients who are admitted to other Patients who are admitted to other hospital units may receive a WASBIRT hospital units may receive a WASBIRT consult if requested by their attending consult if requested by their attending physician.physician.


WASBIRT ProcessWASBIRT Process When a patient enters the emergency When a patient enters the emergency

department WASBIRT staff review their department WASBIRT staff review their status:status: Reason for admission, age, current status, and Reason for admission, age, current status, and

pending consults (radiology, phlebotomy) pending consults (radiology, phlebotomy) If the patient meets the broad eligibility If the patient meets the broad eligibility

requirements WASBIRT services may be requirements WASBIRT services may be provided at anytime during the patients provided at anytime during the patients stay:stay: WASBIRT staff may consult with medical, WASBIRT staff may consult with medical,

nursing, or social work staff either pre or post nursing, or social work staff either pre or post the screening processthe screening process


Staff collect data on personal digital Staff collect data on personal digital assistants and place a note in the patient assistants and place a note in the patient chart.chart.

If a referral for additional services is If a referral for additional services is necessary WASBIRT staff serve as “case necessary WASBIRT staff serve as “case managers” making direct linkages (detox, managers” making direct linkages (detox, traditional inpatient treatment) or arranging traditional inpatient treatment) or arranging appointment times with their brief therapy appointment times with their brief therapy counterpart.counterpart.


Patient ContactPatient Contact

A screening takes approximately 4 A screening takes approximately 4 minutes: minutes: AUDIT and DAST 10AUDIT and DAST 10

A screening and BI takes A screening and BI takes approximately 6 minutes:approximately 6 minutes: Additional GPRA data gathered and brief Additional GPRA data gathered and brief

intervention providedintervention provided A screening with BI and referral A screening with BI and referral

takes approximately 10 minutes:takes approximately 10 minutes: Patient provided with direct referralPatient provided with direct referral


Cost of SBIRT ServicesCost of SBIRT Services

Within the current structure each screen Within the current structure each screen (including a brief intervention and referral) (including a brief intervention and referral) costs approximately $53.00.costs approximately $53.00.

Washington State anticipates being able to Washington State anticipates being able to cut this cost by ½ with reduced cut this cost by ½ with reduced administrative overhead and increased administrative overhead and increased number of screens per FTE.number of screens per FTE.

Co-Occurring Disorders Conference September 29, 2006

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WASBIRT WASBIRT OutcomesOutcomes

Initial Six-Month Follow-Initial Six-Month Follow-upup


Average days of alcohol use in the past 30 days declined significantly

BRIEF BRIEF INTERVENTION INTERVENTION

(n=348)(n=348)

BRIEF INTERVENTIONBRIEF INTERVENTIONPLUS REFERRALPLUS REFERRAL

BUTBUT NO TREATMENT NO TREATMENT (n=152)(n=152)

BRIEF INTERVENTIONBRIEF INTERVENTIONPLUS BRIEF THERAPYPLUS BRIEF THERAPY

OR CD TREATMENTOR CD TREATMENT(n=65)(n=65)

5.5

9.2

17.1

5.5

4.04.1

BEFORE AFTER

26% *Reduction

BEFORE AFTER AFTER

40% *Reduction

77% *Reduction

AFTER

BEFORE

Days

Days

Days

Days

Days

Days


Binge drinking in the past 30 days declined significantly

BRIEF BRIEF INTERVENTIONINTERVENTION

(n=348)(n=348)

BRIEF INTERVENTION PLUS BRIEF INTERVENTION PLUS REFERRAL BUTREFERRAL BUT

NO TREATMENTNO TREATMENT (n=152)(n=152)

BRIEF INTERVENTION PLUS BRIEF INTERVENTION PLUS BRIEF THERAPY OR CD BRIEF THERAPY OR CD

TREATMENT TREATMENT (n=65)(n=65)

2.2

6.1

13.8

3.0

1.71.2BEFORE BEFORE AFTER AFTER

51% *Reduction

BEFORE

46% *Reduction

88% *Reduction

Days

Days

Days


Illegal drug use in the past 30 days declined significantly


(n=348)(n=348)

BRIEF INTERVENTION PLUS BRIEF INTERVENTION PLUS REFERRAL BUTREFERRAL BUTNO TREATMENTNO TREATMENT

(n=152)(n=152)

BRIEF INTERVENTION PLUS BRIEF INTERVENTION PLUS BRIEF THERAPY OR CD BRIEF THERAPY OR CD

TREATMENTTREATMENT(n=65)(n=65)

8.9

8.0

3.3

4.6

3.6

4.4 26% *Reduction

48% *Reduction

55% *Reduction

BEFORE AFTER BEFORE AFTER AFTERBEFORE

Days

Days

Days

Days

Days

Days


Abstinence from both alcohol and other drugs increased for all interventions


(n=348)(n=348)

BRIEF INTERVENTIONBRIEF INTERVENTIONPLUS REFERRAL BUTPLUS REFERRAL BUT

NO TREATMENTNO TREATMENT(n=152)(n=152)

BRIEF INTERVENTIONBRIEF INTERVENTIONPLUS BRIEF THERAPYPLUS BRIEF THERAPY

OR CD TREATMENTOR CD TREATMENT(n=65)(n=65)

2%

32%

25%

51%

16%

10%

3,200%Increase

AFTERBEFORE

153%Increase

96%Increase*

AFTER AFTERBEFORE


Social and Cost Offset Social and Cost Offset AnalysisAnalysis

WASBIRT evaluators are linking with 5 WASBIRT evaluators are linking with 5 external data bases to analyze social and external data bases to analyze social and cost offsets:cost offsets: Washington State Department of Social and Washington State Department of Social and

Health ServicesHealth Services Washington State Department of HealthWashington State Department of Health Washington State Employment Security Washington State Employment Security

DepartmentDepartment Washington State Institute on Public PolicyWashington State Institute on Public Policy Washington State PatrolWashington State Patrol

A fact sheet will be completed by October A fact sheet will be completed by October 2006.2006.

1717Co-Occurring Disorders Conference SeCo-Occurring Disorders Conference September 29, 2006ptember 29, 2006

An Expanded ModelAn Expanded Model

A Continuum A Continuum

of Substance Use Problems, of Substance Use Problems, Interventions, and CareInterventions, and Care

Co-Occurring Disorders Conference SeCo-Occurring Disorders Conference September 29, 2006ptember 29, 2006

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Is SBIRT Risk Reduction?Is SBIRT Risk Reduction?

• If substance abuse is placed on a continuum from abstinence to severe dependence, any move toward moderation and lowered risk is a step in the right direction and not incongruous with a goal of abstinence as the ultimate form of risk reduction.

(Marlatt et al., 1993)


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Why Motivation?Why Motivation?

• Research has shown that motivation-enhancing approaches are associated with greater participation in treatment and positive treatment outcomes.

(Landry, 1996; Miller et al., 1995a)

• A positive attitude and commitment to change are also associated with positive outcomes.

(Miller and Tonigan, 1996)(Prochaska and DiClemente, 1992)


2020

What is Motivation?What is Motivation?

• Motivation is not something one has but is something one does.

• Motivation is a key to change.

• Motivation is dynamic and fluctuates.

• Motivation can be influenced.

• Motivation can be modified.

• The clinician can elicit and enhance motivation.


2121

If it Already Works….If it Already Works….

• Treating those with substance use problems is difficult. We have done well, particularly with those at the far end of the continuum.


2222

Make it Work Even BetterMake it Work Even Better

• Is it possible to expand upon the good work we are doing….and for some patients….help them even more?

• What ideas might help us reach and effectively treat those at an earlier point in the continuum?


2323

Current ViewCurrent View

• The disease of addiction is a progressive condition that, if left untreated, must lead to full dependence and jail, institutions, and death.


2424

Expanded ViewExpanded View

• Substance use disorders exist on a continuum that includes risky use, problematic use, varying levels of abuse, to dependence as defined by the DSM IV.


2525


• Progression is inevitable and automatic.


2626


• Progression is not inevitable or automatic.

• Many individuals never move beyond risky use.

• Many cycle between abstinence, risky use, abuse, and dependence.


2727


• Recovery equals ongoing, stable, long term abstinence.


2828


• Recovery is a multi-dimensional process that differs among people and changes over time within the same person.


2929

ConclusionConclusion

• Research supports changing the way we understand program effectiveness, apply counseling theory, and provide care for the substance using population.


3030

• The current view of substance use as a progressive illness, and recovery as abstinence is being expanded.


3131

• The expanded view of substance use as a continuum and recovery as individually defined is evidence based and supported by practice.


3232

SBIRT AllowsSBIRT Allows• Identification of substance use problems not just

abuse or dependence.• Intervention earlier with less cost and time

intensive care.• Provision of treatment at any place in the

continuum.• Integration of evidence based practice.• Linkages between substance use and public

health, the health care system, and health care providers.


3333

For Additional InformationFor Additional Information

Steve O’NeilWASBIRT Project Director

Washington State Department of Social and Health Services

Division of Alcohol and Substance AbusePO Box 45330 Olympia, WA 98504-5330

Phone: (360) 725-3718Fax: (360) 438-8078

E-mail: [email protected]

1 co-occurring disorders conference september 29, 2006 washington state screening, brief...

Documents

brief intervention patients

drug use brief intervention

brief therapists

brief therapy patient

community services

hospital emergency departments

alcohol andor

hospital inpatient units