Overview of WASBIRT

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Co-Occurring Disorders Conference
Expanding the Continuum Improving Care
Washington State Screening, Brief
Intervention, Referral, and Treatment
Project Stephen H. ONeil, MA, CCDC
III Washington State Division of Alcohol and
Substance Abuse
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WASBIRT Overview

• Nine of Washingtons busiest trauma hospitals,
  located in six separate counties, are hosting 30
  Chemical Dependency Professionals (CDPs) in
• their Emergency Departments (EDs). These
  professionals provide screening, brief
  intervention, and referral for those who need a
  higher level of care.
• Brief therapists located in 11 community agencies
  provide a link to community services.

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Why SBIRT

• Prior studies have shown that interventions, when
  delivered to injured patients in hospital
  emergency departments and on hospital inpatient
  units can
• Reduce alcohol and/or other drug use
• Prevent re-injury and,
• Help patients with more severe problems access
  intensive, community based chemical dependency
  services.

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WASBIRT Services

• Screening Only Patient screened for alcohol
  and/or other drug use brief intervention not
  given.
• Brief Intervention Patients screened for
  alcohol and/or other drug use and receive a Brief
  Intervention in the Hospital.
• Brief Therapy Patient receive a Brief
  Intervention in the hospital plus community based
  Brief Therapy sessions.
• CD Treatment Patient receive a Brief
  Intervention in the hospital plus traditional
  chemical dependency treatment.

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WASBIRT Performance

• Between April 2004 and July 2006 47,809
  screenings have been conducted
• 22,912 screen only (48)
• 23,190 screen and brief intervention (49)
• 1,707 have engaged in additional services (4)

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WASBIRT Structure

• All patients aged 18 and over who present in the
  emergency department are eligible to be screened
  with the following exclusions
• Unconscious or otherwise unable to consent
• (intoxication, psychosis, extreme trauma)
• In police custody
• Patients who are admitted to other hospital units
  may receive a WASBIRT consult if requested by
  their attending physician.

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WASBIRT Process

• When a patient enters the emergency department
  WASBIRT staff review their status
• Reason for admission, age, current status, and
  pending consults (radiology, phlebotomy)
• If the patient meets the broad eligibility
  requirements WASBIRT services may be provided at
  anytime during the patients stay
• WASBIRT staff may consult with medical, nursing,
  or social work staff either pre or post the
  screening process

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• Staff collect data on personal digital assistants
  and place a note in the patient chart.
• If a referral for additional services is
  necessary WASBIRT staff serve as case managers
  making direct linkages (detox, traditional
  inpatient treatment) or arranging appointment
  times with their brief therapy counterpart.

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Patient Contact

• A screening takes approximately 4 minutes
• AUDIT and DAST 10
• A screening and BI takes approximately 6 minutes
• Additional GPRA data gathered and brief
  intervention provided
• A screening with BI and referral takes
  approximately 10 minutes
• Patient provided with direct referral

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Cost of SBIRT Services

• Within the current structure each screen
  (including a brief intervention and referral)
  costs approximately 53.00.
• Washington State anticipates being able to cut
  this cost by ½ with reduced administrative
  overhead and increased number of screens per FTE.

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WASBIRT Outcomes

• Initial Six-Month Follow-up

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Average days of alcohol use in the past 30 days
declined significantly
BRIEF INTERVENTION (n348) BRIEF INTERVENTION PLUS REFERRAL BUT NO TREATMENT (n152) BRIEF INTERVENTION PLUS BRIEF THERAPY OR CD TREATMENT (n65)
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Binge drinking in the past 30 days declined
significantly
BRIEF INTERVENTION (n348) BRIEF INTERVENTION PLUS REFERRAL BUT NO TREATMENT (n152) BRIEF INTERVENTION PLUS BRIEF THERAPY OR CD TREATMENT (n65)
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Illegal drug use in the past 30 days declined
significantly
BRIEF INTERVENTION (n348) BRIEF INTERVENTION PLUS REFERRAL BUT NO TREATMENT (n152) BRIEF INTERVENTION PLUS BRIEF THERAPY OR CD TREATMENT (n65)
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Abstinence from both alcohol and other drugs
increased for all interventions
BRIEF INTERVENTION (n348) BRIEF INTERVENTION PLUS REFERRAL BUT NO TREATMENT (n152) BRIEF INTERVENTION PLUS BRIEF THERAPY OR CD TREATMENT (n65)
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Social and Cost Offset Analysis

• WASBIRT evaluators are linking with 5 external
  data bases to analyze social and cost offsets
• Washington State Department of Social and Health
  Services
• Washington State Department of Health
• Washington State Employment Security Department
• Washington State Institute on Public Policy
• Washington State Patrol
• A fact sheet will be completed by October 2006.

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An Expanded Model

• A Continuum
• of Substance Use Problems, Interventions, and Care

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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?

• 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)

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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.

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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.

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Make 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?

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Current View

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

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Expanded 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.

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Current View

• Progression is inevitable and automatic.

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Expanded View

• Progression is not inevitable or automatic.
• Many individuals never move beyond risky use.
• Many cycle between abstinence, risky use, abuse,
  and dependence.

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Current View

• Recovery equals ongoing, stable, long term
  abstinence.

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Expanded View

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

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Conclusion

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

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

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

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SBIRT 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.

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For Additional Information

• Steve ONeil
• WASBIRT Project Director
• Washington State Department
• of Social and Health Services
• Division of Alcohol and Substance Abuse
• PO Box 45330 Olympia, WA 98504-5330
• Phone [phone]
• Fax [phone]
• E-mail oneilsh_at_dshs.wa.gov