Counselor listening to patient

Screening, Brief Intervention and Referral to Treatment (SBIRT)

A clinicians' tool for identifying risky behaviors and providing appropriate intervention.
Screening, Brief Intervention and Referral to Treatment (SBIRT)
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Overview

Screening, Brief Intervention and Referral to Treatment (SBIRT) is an evidence-based approach to identifying patients who use alcohol and other drugs at risky levels. The goal of SBIRT is to reduce and prevent related health consequences, disease, accidents and injuries. Risky substance use is a health issue that often goes undetected, by incorporating this evidence-based tool that are demonstrated to be valid and reliable in identifying individuals with problem use or at risk for a substance use disorder (SUD) must be used.

SBIRT can be performed in a variety of settings. Screening does not have to be performed by a physician. SBIRT incorporates screening for all types of substance use with brief, tailored feedback and advice. Simple feedback on risky behavior can be one of the most important influences on changing patient behavior.
 

Why use SBIRT? 
  • SBIRT is an effective tool for identifying risk behaviors and providing appropriate intervention.
  • Prevent disease, accidents and injuries related to substance use, resulting in better patient outcomes.
  • By screening for high risk behavior, healthcare providers can use evidence-based brief interventions focusing on health and other consequences, preventing future problems.
  • SBIRT reduces costly healthcare utilization.
  • SBIRT is reimbursable, billing codes are available in New York State. Many payers reimburse for SBIRT services.

Introduction to SBIRT

 

Pre-Screens

A pre-screen, also known as a brief screen, is defined by SAMHSA as "a rapid, proactive procedure to identify individuals who may have a condition or be at risk for a condition before obvious manifestations occur." It involves short questions relating to alcohol and drug use, and must be administered prior to beginning a full screening. Many providers ask patients the pre-screening questions first and then ask the full screening questions if patients score positive on the pre-screening questions. Pre-screens are considered part of routine medical management and are not a separately reimbursable service. Depending on the pre-screening tool used, one or more "yes" replies, may indicate the need for a full screen. 

Commonly used Pre-screens:
 
AUDIT-C - three-item alcohol screen that can help identify persons who are hazardous drinkers or have active alcohol use disorders.
NIAAA - Single-item pre-screener for alcohol use, "How many times in the past year have you had 5 (men)/4 (women) or more drinks in a day?"
DAST-1 - Single-item Question for Drugs, "In the past 12 months, have you used drugs other than those required for medical reasons?"
NIDA- Single-item Question for Drugs - "How many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasons?"
Four Ps- Four question clinical tool for prenatal substance use and abuse. 

Full Screens

Full screens are administered after an individual has screened positive on a pre-screen. Full screens ask a validated series of questions to assess the level of an individual's substance use. Full screens can and should be tailored to the individual. OASAS has approved the following full screens.

 

Adult Screening

Alcohol Use Disorder Identification Test (AUDIT)

AUDIT Manual 
English or Spanish

Questionnaire
English or Spanish

Developed by the World Health Organization (WHO) and evaluated over a period of two decades. It has been found to provide an accurate measure of risk across gender, age, and cultures 

Alcohol, Smoking, and Substance Abuse Involvement Screen Test (ASSIST)

ASSIST Manual
English or Spanish

Questionnaire Available in multiple languages

 Developed by the World Health Organization (WHO) and an international team of substance use researchers as a simple method of screening for hazardous, harmful and dependent use of alcohol, tobacco and other psychoactive substances.  

 

Drug Abuse Screening Test (DAST-10)

Questionnaire

Includes questions about involvement with drugs, not including alcoholic beverages, during the past 12 months. "Drug use" refers to the use of prescribed or over the counter drugs in excess of what’s directed and any non-medical and/or illegal use of drugs.

 

 

Adolescent Screening 

Car, Relax, Alone, Forget, Family or Friends, Trouble (CRAFFT)

CRAFFT Manual
Questionnaire

An alcohol and drug behavioral health screening tool for use with children under the age of 21 and is recommended by the American Academy of Pediatrics' Committee on Substance Abuse for use with adolescents. 

Screening to Brief Intervention (S2BI)
S2BI Manual 
Quick Guide
Questionnaire

A seven-item tool is used to assess the frequency of alcohol and substance use (e.g., tobacco, marijuana, prescription drugs, illegal drugs, inhalants, herbs or synthetic drugs) among youth and adolescents from 12 to 17 years of age.

NIAAA Alcohol Screening for Youth
Manual
Quick Guide

Uses a two-item scale to assess alcohol use among youth and adolescents between 9 and 18 years of age. The first question determines the frequency of friends' drinking, and the second question assesses personal drinking frequency

 

 

Pregnant Women Screening

Tolerance, Annoyance, Cut Down, Eye Opener (T-ACE) 

Questionnaire

A four-item questionnaire developed to assess alcohol use in pregnant women. It provides obstetricians and gynecologists with a brief and useful way to identify patients at risk for drinking amounts which may be dangerous to the fetus.

Tolerance, Worried, Eye Opener, Amnesia, K/Cut Down (TWEAK)

Questionnaire

A five-item scale which was developed originally to screen for risky drinking during pregnancy.

Training

Training 

  • SBIRT Training Providers can be found using the Training Catalog.
  • SBIRT Training Program (4 hours) - Free online, interactive SBIRT training for healthcare professionals offered by Center for Practice Innovations.
  • SBIRT Core Training Program (4 hours) - Online SBIRT training for primary and acute healthcare professionals offered by Clinical Tools, Inc. Note: Behavioral health professionals should consider other OASAS approved options for training.

 Implementation 

 

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