Interview and Intervention

Health Educator Jenny Casselman conducts a brief intervention with "patient" Jacqueline Cornejo (a Health Education Supervisor) at Scripps Mercy Hospital.

Standard screens for alcohol and drug use such as the Alcohol Use Disorders Identification Test and the Drug Abuse Screening Test are administered verbally. Simply asking these questions can serve an educational function, Mr. Ayala says, because patients often respond with uninformed statements such as, "I don't drink alcohol, I just drink beer."

After the educator determines the patient's level of consumption, he or she presents an evidence-based, clinically appropriate intervention. Non-users and those at low risk for abuse receive an educational message that congratulates and encourages them to continue their healthy practices.

Persons found to be at risk because of overconsumption but not yet dependent on drugs or alcohol receive a single, brief, non-judgmental intervention that explains how their consumption compares to medically accepted limits and what the possible consequences may be.

The intervention also encourages patients to change their use patterns. Individuals at high risk because of excessive consumption—but not dependent—receive an appropriate brief intervention plus a referral for one to seven sessions of brief treatment conducted by a specially trained master's- or doctoral-level clinician. These sessions may take place within the same medical setting or at another location.

Finally, persons found to be at severe risk and dependent on alcohol or drugs receive a brief intervention plus referral to a specialized treatment program. CASBIRT can cover the cost of some specialized treatment for people lacking health coverage, but "not more than 15 percent of the dollar value of the grant may be expended in specialty treatment," Mr. Stegbauer says.

The health educator also conveys to the physician the information gathered from the patient's screening for use during the examination. Once the patient has seen the doctor and is preparing to leave the emergency room, the health educator may follow up with "another little reminder," Mr. Ayala says. The patient is told to expect followup by telephone as well.

Back to Top

Creating Effectiveness

The SBIRT program can reduce drug and alcohol use dramatically, followup data show. "The program's raw data show that of at-risk, high-risk, or severe-risk individuals, 62 percent reported stopping drug use and 60 percent reduced their alcohol consumption to low-risk levels," says Mr. Stegbauer.

Preliminary SBIRT data show a total of 74 percent of high-risk individuals reported lowering their drug or alcohol consumption after one or more brief treatment sessions, and 48 percent reported stopping use.

CASBIRT works in part because patients truthfully reveal their behavior, even though it may include the use of illegal substances. "There is a large body of research literature showing that self-report on drug and alcohol use is accurate," says Ms. Peek. "The health care setting is a very effective environment to elicit the truth."

"We're sensitive to the jeopardy concerns that are around these issues, but our focus is on referring each patient to appropriate treatment," Mr. Stegbauer says. "So far, we haven't had any problems." That said, continuing concerns for patients include privacy issues, loss of access to public benefits, and potential reports to health insurance providers.

Another key to success is the quality of the peer health educators. CASBIRT candidates must be bilingual in English and Spanish and have at least a high school diploma and several years' work experience, preferably with public contact. But the "intangibles" are far more important than paper credentials, says Ms. Peek. Peer health educators "absolutely have to be engaging, confident self-starters, because they're going to be dealing not just with the patients but with the doctors" and other hospital staff.

Training includes theory as well as field experience in working with both patients and the protocols and documentation forms used in the interactions. In addition, all aspects of their work are closely monitored and documented. "Our screening form is designed to capture every single aspect of everything they do, as part of our intensive quality assurance system," Ms. Peek says.

But for all the careful training, "you can't train the heart" needed to convey real compassion, Mr. Ayala says. "You've got to already have that."

Because CASBIRT uses peer health educators rather than more highly credentialed professionals to do screening, it also is cost-effective. "We're very encouraged with results thus far," Mr. Stegbauer says.

Adds Mr. Ayala, "This is prevention at its most dynamic."

For more information on the SAMHSA Screening, Brief Intervention, Referral, and Treatment program, visit the SAMHSA Web site at www.samhsa.gov/Matrix/programs_
treatment_SBIRT.aspx. 

Back to Top

« See Part 1: Screening Adds Prevention to Treatment

See Also—Next Article »

Back to Top