Welcome to our SBIRT page.
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We do SBIRT. And then some.
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Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based practice used to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and illicit drugs. Our screening tool, the Healthy Lifestyle Questionnaire (HLQ), is only appropriate for those 18 years of age and older. For screening under the age of 18 the contact is found on the Contact page.
NM Medicaid has made SBIRT a billable service.
NM-SBIRT Beginnings
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The Aim of NM-SBIRT
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The New Mexico (NM) Behavioral Health Services Division, through the joint efforts of Sangre de Cristo Community Health Partnership (SDCCHP; the entity which implemented the SAMHSA funded SBIRT program in NM from 2004-2008), The Life Link, and the University of New Mexico’s Division of Community Behavioral Health, implemented NM Screening, Brief Intervention, and Referral to Treatment (NM-SBIRT) from 2013 to 2018.
Outcomes
Patients with positive screens were categorized into one of three treatment need levels: Brief Intervention (BI), Brief Treatment (BT), or Referral to Treatment (RT). Of those screened, 17% received scores that indicate a brief intervention compared to 15% at the National level and 22% received scores that indicate brief treatment compared to 3% at the National level. Those that screened positive were asked if they were willing to participate in the treatment program. All patients completed at least part of a baseline interview. A randomly selected sample of those also completed follow-up interviews at 6-months and at treatment discharge to track longitudinal outcomes. It should be noted that those categorized as RT were the most likely to be willing to participate (32%), followed by BI (18%) and BT (14%). When contacted for a follow-up interview, those categorized as BI were most likely to respond (58%), followed by BT (49%) and RT (43%) patients. The goal of NM-SBIRT was to provide a universal screen to 48,000 patients, which was exceeded by 1,309 by the end of the project.
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The aims of NM-SBIRT were to expand and enhance the state and tribal continuum of care for substance misuse services and reduce alcohol and drug consumption and its negative health impact; increase abstinence; reduce costly health care utilization; and promote sustainability of SBIRT services through the use of health information technology and policy change. NM-SBIRT was designed to expand and enhance the state’s continuum of care to include universal adult SBIRT services in primary care and community health settings and support clinically appropriate services for adults 18 or over at risk for, or diagnosed with, a substance use disorder.
What made the NM SBIRT different?SBIRT has been implemented differently depending on each site and each state. Some of the unique features of New Mexico SBIRT implementation included: 1) Universal screen was 13- questions long, instead of 3, and it was based on the following assessment tools: a) Audit, b) Drug Abuse Screening Test (DAST), c) Primary Care PTSD Screen (PC-PTSD), and d) Generalized Anxiety Disorder (GAD) scale, 2) The use of a Certified Peer Support Workers alongside a Behavioral Health Counselor, 3) PSWs and BHC were NMSBIRT staff not clinic staff, 4) Training and capacity building provided to both PSW and BHC on Motivational Interviewing, IMPACT, Seeking Safety, and CRA 5) Provided up to 3 MI sessions for anyone that screened SBIRT positive 6) Provided up to 12 therapy sessions for anyone who screened BT, and 7) Training and administrative support was provided to partnering clinic staff (medical providers, medical assistants, front desk staff, etc.).
The model we use is a multi-faceted approach that had very good outcomes. Although it is tempting to utilize only the screen and intervention, the best effects for the patients included behavioral health counseling utilizing particular clinical tools. |
NM SBIRT OVERVIEW
In August 2013, SAMHSA awarded BHSD with a five-year, $10 million grant to implement SBIRT. SBIRT services integrate behavioral health within primary care and community medical health care settings.Each medical partner site universally screens adult patients 18 years old or over, at a minimum, on an annual basis, but preferably, every three months, to identify those at-risk of or those who have a substance use disorder.
Although usually, SBIRT models are typically specific to addressing substance use/misuse only, NM SBIRT ‘s HLQ was purposefully formulated to include mental health (MH) questions to better serve our population’s needs. The NM SBIRT Healthy Lifestyle Questionnaire (HLQ) pre-screen score identifies when a patient scored positive for NM SBIRT, at risk of having or has substance misuse and/or a co-occurring disorder or MH only. The (HLQ), includes 14 questions from evidence-based screening tools, such as the AUDIT 10 (screens for alcohol), DAST (screens for drug).The HLQ also devised to include questions that identified if has symptoms of depression, anxiety, and/or trauma. These additional mental health questions were formulated utilizing the GAD-7 (screens for Anxiety); PCL-C (screens for PTSD); and PHQ-9 (screens for depression).These instruments were utilized in entirety for some therapy patients, as appropriate and indicated.
Teams comprised of a Certified Peer Support Workers (CPSWs) and a Behavioral Health Counselors (licensed counselors or therapists or social workers) were co-located at each partnering medical facility. Utilizing teams in this fashion made it possible for real-time warm hand-offs from providers to NM SBIRT teams. Because of that, CPSWs typically were able to provide immediate brief interventions and limited case management or referral to treatment. Patients, NM SBIRT staff were unable to speak to following the appointment/screening, due to patient or provider time constraints, were given follow-up calls and appointments, if the patient chose to return. Brief interventions were conducted with patients that screened positive, screen scores were reviewed, and motivational interviewing was utilized. Therapy was usually available within a week, taking advantage of the “window of opportunity” to engage patients in need. Considering the reality of dearth of treatment options throughout the state accompanied by long, often 3-6 month waiting lists, having immediate access to therapy proved fruitful and was extremely beneficial to patients who may have otherwise lost interest and impetus to pursue help.
We found that utilizing CPSWs was very instrumental in enhancing patient engagement. Patients learning that they were speaking with persons with lived experience were more prone to open up and further disclose, more often, compared to with medical providers. Some were re-screened during BIs because of the level of comfort disclosing more during discussions with peers. Therapists often re-screened as well when patients became more comfortable and aware of their issues with AOD (alcohol and other drugs) use and/or MH. There is little doubt that this contributed to further demonstrating what we already knew about high rates of AOD use/misuse and MH facing NM patients.
Patients scoring at moderate to high risk for AOD were eligible for 12 free on-site therapy sessions provided by NM SBIRT Behavioral Health Counselors. Following those sessions if patients determined they wanted to continue on, therapists facilitated referrals to other treatment resources. In addition, in some medical settings, the waitlist for internal therapists were 3-6 months, thus SBIRT services served to close the gap; patients would complete SBIRT therapy and move right into the in-house therapy. Patients scoring positive for depression, anxiety, and PTSD were eligible for 3 on-site brief intervention sessions using motivational interviewing and were referred for additional treatment once the three sessions were completed, if they chose to do so. Providing therapy on-site was not only more practical and more easily accessible to patients but was also a welcomed addition to medical sites having no behavioral health services on-site prior to SBIRT and the medical- behavioral health integration for whole person care.
HOW TO GET CERTIFIED
LLTI is currently certifying Healthcare Facilities in SBIRT in order for them to bill Medicaid for these services. There are five components to certification.
1. SBIRT for Administrators/Supervisors. This one-hour training is for those individuals within the facility with decision making authority. This must be completed prior to scheduling the additional trainings.
2. SBIRT for Support Staff front desk/reception and others whose role is to pass out screens. This is also a one-hour training.
3. SBI Track-Screening, Brief Interventions and Referals to Treatment. This is a three-hour training required for staff who will be scoring, interpreting results and providing brief interventional with patients.
4. SBIRT for Providers. This is a one-hour training for those who deliver medical care, i.e., Drs, PAs, CNPs. We will make an overview of the Healthy Lifestyle Questionnaire (HLQ).
5. Motivational Interviewing (MI) for Peers and Clinics. This a two-day training and is required for those who do brief interventions. Staff who will be providing SBIRT interventions should complete the full two-day MI training with a Motivational Interviewing Network of Trainers (MINT) trainer with the past two years.
Our full training calendar is available by going to: https://www.lltraininginstitute.org/llti-calendar.html
If you are needing a training and don't see it on our calendar, please feel free to contact Augusta Candelaria at 505-795-5050 or [email protected].
Once a facility is certified, they are eligible for a one-time $7,500 enhancement payment.
In August 2013, SAMHSA awarded BHSD with a five-year, $10 million grant to implement SBIRT. SBIRT services integrate behavioral health within primary care and community medical health care settings.Each medical partner site universally screens adult patients 18 years old or over, at a minimum, on an annual basis, but preferably, every three months, to identify those at-risk of or those who have a substance use disorder.
Although usually, SBIRT models are typically specific to addressing substance use/misuse only, NM SBIRT ‘s HLQ was purposefully formulated to include mental health (MH) questions to better serve our population’s needs. The NM SBIRT Healthy Lifestyle Questionnaire (HLQ) pre-screen score identifies when a patient scored positive for NM SBIRT, at risk of having or has substance misuse and/or a co-occurring disorder or MH only. The (HLQ), includes 14 questions from evidence-based screening tools, such as the AUDIT 10 (screens for alcohol), DAST (screens for drug).The HLQ also devised to include questions that identified if has symptoms of depression, anxiety, and/or trauma. These additional mental health questions were formulated utilizing the GAD-7 (screens for Anxiety); PCL-C (screens for PTSD); and PHQ-9 (screens for depression).These instruments were utilized in entirety for some therapy patients, as appropriate and indicated.
Teams comprised of a Certified Peer Support Workers (CPSWs) and a Behavioral Health Counselors (licensed counselors or therapists or social workers) were co-located at each partnering medical facility. Utilizing teams in this fashion made it possible for real-time warm hand-offs from providers to NM SBIRT teams. Because of that, CPSWs typically were able to provide immediate brief interventions and limited case management or referral to treatment. Patients, NM SBIRT staff were unable to speak to following the appointment/screening, due to patient or provider time constraints, were given follow-up calls and appointments, if the patient chose to return. Brief interventions were conducted with patients that screened positive, screen scores were reviewed, and motivational interviewing was utilized. Therapy was usually available within a week, taking advantage of the “window of opportunity” to engage patients in need. Considering the reality of dearth of treatment options throughout the state accompanied by long, often 3-6 month waiting lists, having immediate access to therapy proved fruitful and was extremely beneficial to patients who may have otherwise lost interest and impetus to pursue help.
We found that utilizing CPSWs was very instrumental in enhancing patient engagement. Patients learning that they were speaking with persons with lived experience were more prone to open up and further disclose, more often, compared to with medical providers. Some were re-screened during BIs because of the level of comfort disclosing more during discussions with peers. Therapists often re-screened as well when patients became more comfortable and aware of their issues with AOD (alcohol and other drugs) use and/or MH. There is little doubt that this contributed to further demonstrating what we already knew about high rates of AOD use/misuse and MH facing NM patients.
Patients scoring at moderate to high risk for AOD were eligible for 12 free on-site therapy sessions provided by NM SBIRT Behavioral Health Counselors. Following those sessions if patients determined they wanted to continue on, therapists facilitated referrals to other treatment resources. In addition, in some medical settings, the waitlist for internal therapists were 3-6 months, thus SBIRT services served to close the gap; patients would complete SBIRT therapy and move right into the in-house therapy. Patients scoring positive for depression, anxiety, and PTSD were eligible for 3 on-site brief intervention sessions using motivational interviewing and were referred for additional treatment once the three sessions were completed, if they chose to do so. Providing therapy on-site was not only more practical and more easily accessible to patients but was also a welcomed addition to medical sites having no behavioral health services on-site prior to SBIRT and the medical- behavioral health integration for whole person care.
HOW TO GET CERTIFIED
LLTI is currently certifying Healthcare Facilities in SBIRT in order for them to bill Medicaid for these services. There are five components to certification.
1. SBIRT for Administrators/Supervisors. This one-hour training is for those individuals within the facility with decision making authority. This must be completed prior to scheduling the additional trainings.
2. SBIRT for Support Staff front desk/reception and others whose role is to pass out screens. This is also a one-hour training.
3. SBI Track-Screening, Brief Interventions and Referals to Treatment. This is a three-hour training required for staff who will be scoring, interpreting results and providing brief interventional with patients.
4. SBIRT for Providers. This is a one-hour training for those who deliver medical care, i.e., Drs, PAs, CNPs. We will make an overview of the Healthy Lifestyle Questionnaire (HLQ).
5. Motivational Interviewing (MI) for Peers and Clinics. This a two-day training and is required for those who do brief interventions. Staff who will be providing SBIRT interventions should complete the full two-day MI training with a Motivational Interviewing Network of Trainers (MINT) trainer with the past two years.
Our full training calendar is available by going to: https://www.lltraininginstitute.org/llti-calendar.html
If you are needing a training and don't see it on our calendar, please feel free to contact Augusta Candelaria at 505-795-5050 or [email protected].
Once a facility is certified, they are eligible for a one-time $7,500 enhancement payment.
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