Directions - Please make sure your computer speakers are on, there will be audio and videos that will be important to your learning. This is an interactive course, you will need to click objects to reveal important information

Goals - Welcome to our SBIRT course Screening, Brief Intervention and Referral to Treatment! This course includes three modules. After completing all of the modules, you will be able to:

• Define important components of SBIRT
• Identify screening tools commonly used when conducting SBIRT
• Understand the benefits and challenges of implementing SBIRT
• Take home a variety of SBIRT resources

Three Modules - This SBIRT course is divided into three segments. First, you will learn about Screening, then about Brief Intervention and lastly, you will learn about Referral to Treatment. After completing the three modules will you be asked to complete a post-test to obtain Continuing Education certificate.

Introduction to SBIRT Transcript - SBIRT is an evidence-based practice model that looks at system change and incorporates how can we improve identifying patients who are having harmful patterns of use for alcohol and other drugs. Dr. Umeika Stephens I am the graduate program director for the psychiatric nurse practitioner program here in the College of Nursing at Wayne State and I'm also a principal investigator on an SBIRT training grant that trains Social Work students nursing students and healthcare professionals on how to use SBIRT in practice. So I use SBIRT actually in my training of my students and actually in my practice so I currently work as part of the CO service for Henry Ford health system and I have worked in a private practice and I utilize SBIRT the screenings and the intervention in both of my practices. Because typically what do we spend a whole bunch of time doing? Trying to figure out how we are going to get them to change. You can just ask them: What would it take for you to be an 8? A miracle. Alright miracles, okay so we need prayer, that's my answer if they say a miracle. Prayer... (inaudible) So SBIRT has been around for a long time it was actually developed in the early 1980s by the World Health Organization. And it's been here in the US predominately since about 2003 it's been funded by SAMHSA which is the substance abuse administration and so there have been state-level grants and very similar training grants to the ones we have to increase the use amongst providers so I've actually been using SBIRT now for about four years I have been doing the AUDIT as a part of my normal practice but I've been using the actual full SBIRT tools for about the last four years as a part of this training grant so harm reduction actually typically in most, any public health model you have something that's either abstinence so we know very much about abstinence based models harm reduction actually looks at we say that we understand that you are going to have a pattern of you so say if you drink first it's telling somebody they have to stop drinking our harm reduction model would say how can we reduce your drinking to actually reduce the overall harm that the patient would have as related to their health conditions so we know that if you drink six days a week and we get you to drink three days a week then we've actually reduced the harm that you're doing to yourself by about 50% This is really, when we're talking about SBIRT this is identifying risk. So this would be an ER, this would be an outpatient center like it wouldn't necessarily be on a substance-abuse side that because there's a whole different set of parameters if you're actually working in substance-abuse. It really was as I started with this grant I realized that it was such a necessary skill set that was needed to not only for my personal practice but also for how I trained my students especially as we see this current opioid crisis we really need to be able to create providers that understand how to assess their patients and how do we actually be able to engage them so that we can actually decrease their harmful use you can actually train anyone you don't have to have a degree you can have a layperson you can do it in churches it can actually be utilized in any mechanism it's a very flexible model and actually has a lot of I kind of think of it like a lego system you take the pieces that work well for your practice but you are always able to keep the core components and impact their overall use So when you think about the fact that I can have SBIRT in my church I can have it at my school I can receive SBIRT services in the ER it makes it effective because it is so flexible so it's not just when you go to see your doctor you actually can have an SBIRT intervention in the places that people actually would probably be a little bit more open to listen. What is a typical day like for you? Because sometimes once they start to talk about all of their stressors all the things that are overwhelming them their how the substance fits in to that stress relief it helps you to understand what kind of connection they made to substance use. I really think SBIRT in the next five to ten years will actually even take off even further I mean we've seen a lot of improvement or increase in use since 2003 but especially now that we have this current opioid crisis providers are really seeking out a way to engage patients that have a conversation that they don't always feel like they were really trained to do and so having an opportunity to do something like SBIRT it really helps to decrease the providers anxiety but also they give them a skill set that's really gonna impact with our current opioid crisis so I really see in the next five to ten years it'll be something that becomes a natural part of practice. So my advice to Social Work and nursing students or anyone who's just starting out using SBIRT is to really be patient with yourself this a really new skill set and it's a skill set that creates some anxiety in people so you really have to give yourself a time to practice it and really be open and let your patients know okay this is something that we're doing new explain to them while that this may be your first or second time doing it and that that you are still learning this skill set but how important it is for their overall health so just be patient with yourself and give yourself some  time to practice. This is actually across 10 countries and it was specifically looking at alcohol and what they found was even after 5 minutes they got about 20% of people to reduce their use, with 5 minutes. Because what is the other thing people in healthcare say we don't have? Time. I don't have time to be in there for 30 minutes talking to someone about their addiction. You don't need 30 minutes; this intervention can be done in 10 minutes or less. If someone is interested in learning more about SBIRT if they could just visit the website listed below (www.sbirt.wayne.edu/resources) is for SAMSA and it will give them a whole host of resources and tools and also information about finding about trainings in their area.

Importance of Clarification - A drink can be different for everyone. It is vital to clarify with your patient about the amount of alcohol they're consuming. Please click the picture below to watch a health care professional clarify what a drink is with her patient.

Sheryl Clarification Transcript - Okay, so it's closer to the three and then it says usually drink three or four drinks when you do drink? So what is a drink for you? Um, a glass of wine or um a bottle of beer. Sometimes I'll have like a mixed drink or just whiskey. Okay, so typically is it really kind of you kind of mix it back and forth Um, I know you'll start with beer and then I'll end it with something different. Okay. It depends how stressed I am. Okay, so what kind of beer are you drinking? Are you drinking just a regular beer like a Bud Light or you'd like one of fancy beer drinkers? No I don't like all the hops and stuff. Okay. I'm just like Budweiser. Okay, and then are you drinking like, are you going with the big beers or is this you know like happy hour time? Happy hour they, the bigger ones are like cheaper so... Okay. So like a 20 ounce? Yeah. All right. And then with the wine are you drinking... Um, typically like just a regular glass of wine, or do you buy the bottle? No, if I'm out it's like normally beer but at home I can I'll just fill my glass to the top Alright, and then you said a little bit about whiskey. Is whiskey kind of hit or miss? It depends, I mean if we're doing like a work party, we're celebrating we'll open something a little stronger Okay, so whiskey tends to be like a celebrate? Yeah. Okay

Sam Screening - Now that you have learned about the screening process it is time to watch it in action. In this training video Sam, a 28-year-old male, is a patient who was admitted into the emergency department after a car accident. Upon admission, Sam completed several screening tools. Please click the picture to start the training video.

Sam Transcript - So a part of our new protocol is that we screen everybody for alcohol and substance use so I just want to go over some of the questionnaires that you answer for us earlier. Is that okay? Go for it. Alright. So the first one we're gonna look at is actually the one you answered about your alcohol use. Mm-hmm. And so you're showing right now that you're drinking alcohol at least two to four times a month? Yeah, you know, like I said every weekend every other weekend, all right. And then it's saying that you're drinking about five to six drinks each time. Yeah. Okay. What kind of drinks do you like? I am a vodka soda splash of cran kind of boy. Okay. Alright, and then how often um, it says on that you have five or more drinks on one occasion Is that every time you go out or is there sometimes that you drink a little bit less? Sometimes it drink a little bit less but most of the time it's five or more. Okay, so most the time it's gonna be at least five? Yeah. Okay. Alright. And then in the last year, you said that you've had issues. That you were not able to stop drinking what she started. So once the party starts it started. Once the party starts it started that is exactly how it goes. And then you say that at least that you fail to do what was normally expected because of your drinking. Yeah. Okay, so tell me a little bit about it, you know like household work that needs to get done, paying bills, you know, just sort of like the stuff that you have to take care of on the weekends and occasionally like I might miss a Monday at work if I had a rough weekend. How many miss Mondays are we saying maybe in the last year? Um like at least five or six in the past year probably. Okay so at least five or six out of the last year, you've had to kind of stay home on Monday to kind of recuperate? Yeah, I'm using those vacation days. So your vacation is at home? Alright, and so you said that you've never had to have a drink first thing in the morning that never happened? No. You feel like you have a drink. Alright, and then that at least monthly or less than monthly you feel guilty about your drinking? What's going on with that? Yeah. My boyfriend really doesn't like it when I when I drink a lot or when I'm using sort of those other party drugs. He gets pretty angry. Okay. So now the drinking has actually caused some issues in your relationship because he doesn't really...? Yeah, yeah, you could say that. Okay. How long would you say that you've been? Drinking or partying at this level like with the with the mixing of the marijuana and some of the heroin. How long has that been going? I mean, I've probably been drinking for like eight years. The weed and the heroin like four years probably. Okay and then you also said that you've had at least once during the last year that someone was injured because you're drinking. Well, somebody else injured or was that you? No, I was talking about myself. Alright. So you said but there was never another time other than this, are we talking about this time? I'm talking about this time. Okay, what about any time you've had an injury that maybe didn't bring you to the ER so maybe a trip and fall or something like that? You know, I've stumbled down some steps before I'm not the most graceful human being so it happens. Okay. Now did any of those times that that requires for you to go to see your regular doctor or this was something you kind of were able to take care of on your own? No I just take care of it at home. Okay. And then so you said you had a relative or friend that wanted you to cut down? Was that is that your boyfriend or is there somebody else it also has talked? It's my boyfriend. Okay, and then let's look at this other screen. So you told me that you also are using the you're also using heroin and marijuana, so, how…how are you using the heroin? How is that? Is it smoked? Yeah. I'm rolling it in with the marijuana. Okay. All right, and have you ever noticed any problems at all with your breathing or anything like that related? So when you're smoking, I mean I get a little bit wheezy. Okay.

Purpose of Screening - Introducing the purpose of screening to your patient is extremely important to obtain accurate responses. Here is a short script you can use to introduce screening to your patient. Move the green slider button located at the bottom of the page to listen to the example

Final Screening Slide - Please go to our "Resources" page to download any or all of the screening tools we have reviewed today