Interview and Intervention
|
Health Educator Jenny
Casselman conducts a brief intervention with "patient"
Jacqueline Cornejo (a Health Education Supervisor)
at Scripps Mercy Hospital. |
The interview begins with the health educator offering
to do something to make the patient more comfortable—bringing
an extra pillow or phoning a family member, for example.
The educator also explains his or her role as one of helping
the doctors who will treat the patient by obtaining information
about the patient's use of medications, non-medical drugs,
and alcohol over the past 12 months, all of which can affect
health and medical treatment.
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.
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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.
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Current SBIRT Projects
SAMHSA awarded funding in 2003 to six states and
one tribal council over 5 years for the Screening,
Brief Intervention, Referral, and Treatment program.
A short description follows of each grantee:
-
California is expanding the
San Diego model (see Screening
Adds Prevention to Treatment—Part 1)
to other clinics, emergency rooms, and trauma
centers.
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Alaska's Cook Inlet Tribal Council
is serving Alaska Natives in Anchorage.
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Illinois is providing services
at hospitals, emergency rooms, and clinics
in Cook County.
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New Mexico is targeting rural
and non-ethnic populations in three of its
five health regions.
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Pennsylvania is serving targeted
populations of adults in general medical and
other community settings in five counties.
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Texas is providing services
within the Harris County Hospital District
in the Houston metropolitan area.
-
Washington State is serving
five hospital emergency departments in counties
with the largest volume of emergency room patients.
In addition, SAMHSA recently awarded 12 grants
for brief interventions with college and university
students at risk of substance abuse. For more information,
visit SAMHSA's Web site at www.samhsa.gov/news
/newsreleases/
050706_college.html. |
« See Part 1: Screening Adds Prevention to Treatment
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