Screening, Brief Intervention, and Referral to Treatment (SBIRT) as an Integral Part of Nursing Practice

Utilization of Nurse-Administered Screening, Brief Intervention, and Referral to Treatment in a Brief Psychiatric Inpatient Unit

BACKGROUND

Screening, Brief Intervention, and Referral to Treatment (SBIRT) has been established as an effective screening tool for providing interventions for patients with risky substance use.

OBJECTIVES

The objectives of this project were to train and coach staff nurses in the use of SBIRT, offer SBIRT to all admissions of a brief psychiatric inpatient unit, and decrease readmission rates.

DESIGN

Using the Iowa Model for Implementing Evidence-Based Practices, SBIRT was implemented on the unit. Data were collected on the frequency of patients offered SBIRT and readmission rates.

RESULTS

Fifty-nine percent of all admissions were offered SBIRT. The average readmission rates decreased by 18.3% for the first 2 months of implementation and by 67.5% for Days 16-31 postdischarge.

CONCLUSIONS

SBIRT is an effective tool for nurses on psychiatric units to address substance use and to decrease readmission rates.

Implementing SBIRT to Address Maternal Marijuana Use

A quality improvement project conducted at 3 Texas hospitals to implement a new systematic process to address maternal marijuana use among breastfeeding mothers. The new process was created using the evidence-based Screening, Brief Intervention, Referral to Treatment (SBIRT) model to address maternal marijuana use. Nurses screened all postpartum mothers for marijuana use at each of the 3 hospitals. Mothers who reported ever using marijuana were advised to abstain while breastfeeding and given educational materials and a treatment referral card. Among all 3 hospitals, the mean nurses' adherence to the SBIRT process was 69 percent, exceeding the project aim of 50 percent adherence. SBIRT, which has been used extensively with other populations and settings, was easily translated into practice for use with postpartum mothers who reported using marijuana. A systematic process using SBIRT may help mitigate the risk of harm for infants of mothers who use marijuana.

Health Care Providers' Perceived Barriers to Screening for Substance Use During Pregnancy

OBJECTIVE

To explore health care providers' perceived barriers to conducting standardized screening processes for substance use during pregnancy.

DESIGN

Descriptive survey.

SETTING/LOCAL PROBLEM

A health system in the northwestern United States where there was a lack of consistent substance use screening in prenatal clinics.

PARTICIPANTS

A convenience sample of 12 women's health care providers from two hospitals in the health system, including obstetricians/gynecologists, women's health nurse practitioners, women's health physician assistants, and certified nurse-midwives.

INTERVENTION/MEASUREMENTS

We created a 16-item questionnaire that identified potential barriers to screening, such as education/resources for providers, screening tools, referral processes, legal implications, patient relations, and infrastructure.

RESULTS

A majority (n = 8, 66.7%) of participants indicated they had received adequate training regarding substance use during pregnancy and felt comfortable asking pregnant women about their substance use. All (n = 12, 100%) providers indicated that women would feel safe disclosing their substance use but might feel offended if their provider asked them about it. Although most reported screening women for substance use, they did not use a consistent screening tool or process. Participants identified lack of time, legal concerns, and lack of access to resources for referrals as other barriers to screening.

CONCLUSION

Clinicians perceive barriers to screening for substance use during pregnancy, and they may be unaware of legal implications for patients related to perinatal substance use. Identifying barriers to universal screening may facilitate development of best practices related to counseling patients about substance use during pregnancy.

A Review of Chronic Comorbidities in Adults Living With HIV: State of the Science

ABSTRACT

People living with HIV are living longer, high-quality lives; however, as they age, this population is at increased risk for developing chronic comorbidities, including cardiovascular disease, certain types of cancer (e.g., lung, anal, and liver), and diabetes mellitus. The purpose of this state-of-the-science review is to provide an evidence-based summary on common physical comorbidities experienced by people living and aging with HIV. We focus on those chronic conditions that are prevalent and growing and share behavioral risk factors that are common in people living with HIV. We will discuss the current evidence on the epidemiology, physiology, prevention strategies, screening, and treatment options for people living with HIV across resource settings.

Strategies for Alcohol Screening, Brief Intervention, and Referral to Treatment Sustainability in the Emergency Department

Alcohol misuse remains the fourth leading cause of preventable death in the United States, with nearly 90,000 deaths occurring annually as a consequence of alcohol misuse. Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based strategy that includes initial screening using a valid tool, determining the need for intervention, a brief motivational interview, and referral to treatment leading to follow-up care when necessary. Although an abundance of evidence-based practices now exist as a guideline for quality patient care, an inconsistency persists between protocols supported by research and those actually integrated into daily clinical practice. Currently, there is little in the literature examining the sustainability of SBIRT programs in emergency departments. The authors examine challenges to SBIRT implementation in the emergency department and propose a number of strategies to ensure continued sustainability of this evidence-based practice.

Interactive Computer Simulation for Adolescent Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Substance Use in an Undergraduate Nursing Program

PURPOSE

Adolescent substance use has been identified as our nation's number one public health problem. Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based approach to identify and address adolescent substance use. Despite recommendations for universal implementation, adolescent SBIRT training has been notably absent from undergraduate nursing curricula. This project describes and evaluates the effectiveness of using an interactive computer simulation for adolescent SBIRT in an undergraduate nursing program.

DESIGN AND METHOD

Undergraduate nursing students (n = 144) completed an adolescent SBIRT interactive computer simulation (SBI with Adolescents, Kognito). Self-perceived competence, confidence, and readiness to deliver adolescent SBIRT were measured via pre- and post-survey items. Student attitudes toward substance use and simulation-based learning were also studied. At the end of the simulation, students received an automatic assessment challenge score based on performance. We compared the pre- and post-SBIRT scores using the Wilcoxon signed rank test and the sign test for repeated measures using 2-tailed α = 0.05.

RESULTS

We saw significant (p < .05) improvement in overall student competence, confidence, and readiness to deliver SBIRT. Positive quantitative and qualitative feedback were also received regarding the simulation experience.

CONCLUSIONS

Adolescent SBIRT training was successfully integrated into an undergraduate nursing curriculum. There were significant improvements in self-reported competence, confidence, and readiness to deliver adolescent SBIRT.

PRACTICAL IMPLICATION

This project provided further support for the potential benefits of an interactive computer-based simulation in an undergraduate nursing curriculum.

Engaging Youth (Adolescents and Young Adults) to Change Frequent Marijuana Use: Motivational Enhancement Therapy (MET) in Primary Care

PURPOSE

To characterize information elicited from adolescent/young adults with frequent cannabis use in Motivational Enhancement Therapy (MET), and determine whether differences exist across stages of change (SOC) for reducing use.

DESIGN AND METHODS

Primary care patients 15-24 years old using cannabis ≥3 times/week enrolled in a pilot randomized intervention trial. All youth were offered two 1-hour MET sessions. Content analysis was used to code and categorize main reasons for use, alternative behaviors, goals, values, pros and cons of change, and compared results between youth in Pre-Contemplation vs. Contemplation SOC.

RESULTS

Fifty-six youth completed MET session 1, 46 completed session 2. Most reported their main reason for use was related to emotional coping, negative feelings were a top-3 trigger, and distraction was an alternative way to meet their needs. Youth most frequently described progress in education or career/job as 1-year goals. More than half identified family as a very important value. They most frequently reported pros of using less related to achieving goals, self-improving, and saving money, and a con related to stress/coping. Compared to youth in Pre-Contemplation SOC, those in Contemplation were more likely to identify relationships as both a pro and con of using less cannabis.

CONCLUSIONS

MET can reveal developmentally appropriate goals, healthy values, and ambivalence about cannabis use that can be used to facilitate movement along the stages of behavior change toward reduction/cessation.

PRACTICE IMPLICATIONS

Brief motivational therapy can be used in primary care to gather information important in helping youth to reduce cannabis use.

Variation in SBIRT delivery among acute care facilities

BACKGROUND

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based process to recognize and intervene with people who use substances. Despite evidence to support the SBIRT effectiveness, this process is rarely used in acute care. To facilitate use of SBIRT in acute care, it is important to first understand the implementation processes.

PURPOSE

To describe SBIRT processes across 14 acute care facilities.

METHODS

A phone interview was conducted with site coordinators at 14 facilities to describe their SBIRT process and clinicians involved in each step.

FINDINGS

Seven different SBIRT processes were identified for people that use alcohol and/or drugs, and five different processes were identified for people that use tobacco. The function of SBIRT was consistent throughout facilities, but the form of implementation varied based on organizational context.

DISCUSSION

Future SBIRT dissemination efforts will need to first understand the local processes and clinicians involved within each facility to tailor implementation to local context.

Nurses and Fetal Alcohol Spectrum Disorders Prevention

Women of reproductive age who are drinking alcohol and not using effective contraception are at-risk for an alcohol-exposed pregnancy, which could result in a child with a fetal alcohol spectrum disorder (FASD). Nurses are an important partner in addressing at-risk alcohol use. It is imperative for alcohol education to be incorporated into nursing curricula so that future nurses have the tools to identify at-risk alcohol use. Three universities have worked together to create Fetal Alcohol Spectrum Disorders: A Toolkit. This toolkit was designed for nurses to facilitate the recognition and prevention of FASD and address gaps that exists around alcohol use.

Distance Versus On-Site Educational Strategies for Competency-Based Screening, Brief Intervention, and Referral to Treatment Education

BACKGROUND

Although the individual and public health consequences of alcohol and drug use are substantial, nursing education programs generally lack content on addiction. The goal of this evaluation was to compare the initial outcomes of on-site versus distance methods for training graduate nurse practitioner students in Screening, Brief Intervention, and Referral to Treatment (SBIRT) for substance use.

METHOD

A nonrandomized two-group pretest-posttest design was used to compare knowledge, attitudes, and skills learning outcomes between on-site (n = 45) and distance (n = 18) family or adult/geriatric Master of Science in Nursing nurse practitioner students receiving SBIRT training.

RESULTS

Overall, students increased their knowledge, attitudes, and confidence about screening and intervening with patients who use substances; showed a high level of skills in conducting a brief intervention to motivate patients to reduce their substance use; and were highly satisfied with the education provided. Counseling confidence and gains in knowledge were similar across groups. Compared with distance students, on-site students reported significantly more positive attitudes about their role adequacy, role legitimacy, and role support for intervening with alcohol use and about their role support for intervening with drug use. On-site students had greater training satisfaction, but distance students' skills assessed through standardized patient interactions were significantly better.

CONCLUSIONS

Both on-site and distance training were effective instructional methods to increase SBIRT knowledge and skills. However, differences in attitudes, training satisfaction, and skills demonstration should be taken into account when designing addiction training using distance technologies.

Comparison of Instructional Methods for Screening, Brief Intervention, and Referral to Treatment for Substance Use in Nursing Education

Most nursing programs lack curriculum on substance use. This project evaluated 3 didactic instructional methods for teaching baccalaureate nursing students about screening, brief intervention, and referral to treatment for substance use. In-person, asynchronous narrated slides and interactive online instructional methods were all effective in developing students’ competency; however, active learning methods (in-person and interactive online course) were more effective in changing students’ attitudes about their role in screening and intervening for drug use.

Implementing Interprofessional Alcohol Screening, Brief Intervention, and Referral to Treatment in the Emergency Department: An Evidence-Based Quality Improvement Initiative

Alcohol misuse is one of the leading causes of illness, disease, injury, and death in the Unites States. For many patients, the emergency department (ED) visit may provide the only therapeutic opportunity to influence problematic drinking behavior. Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based approach that may reduce alcohol-related morbidity and mortality and improve health outcomes and quality of life. Developing and implementing an alcohol SBIRT educational module for ED nurses and social workers is an efficient and effective mechanism to provide education about alcohol SBIRT, and revising the electronic health record to include an alcohol SBIRT protocol provides a standard mechanism for documentation by the interprofessional team of ED nurses and social workers. By integrating SBIRT knowledge as standard of practice in the ED setting, providers can positively impact the health and well-being of patients.

Alcohol and Substance Use Disorder Screening, Brief Intervention, and Referral to Treatment Among People Living With HIV/AIDS

PURPOSE

The purpose of this review is to inform nurses on the prevalence of substance use screening with screening, brief intervention, and referral to treatment; its use in the primary care setting; and its effectiveness on HIV-related risk behaviors to prevent adverse health consequences among people living with HIV/AIDS (PLWH).

REVIEW

For PLWH, identification of at-risk substance use is important because of the association between substance use and HIV infection both in terms of acquiring HIV and in further transmission of HIV.

CONCLUSION

Alcohol and substance use disorders continue to be a burden for PLWH and are associated with poor health outcomes. Implementation of screening, brief intervention, and referral to treatment in the primary care setting is critical for promoting positive health outcomes in this population and provides an opportunity for nurses to intervene.

A Brief Patient Self-administered Substance Use Screening Tool for Primary Care: Two-site Validation Study of the Substance Use Brief Screen (SUBS)

BACKGROUND

Substance use screening is widely encouraged in health care settings, but the lack of a screening approach that fits easily into clinical workflows has restricted its broad implementation. The Substance Use Brief Screen (SUBS) was developed as a brief, self-administered instrument to identify unhealthy use of tobacco, alcohol, illicit drugs, and prescription drugs. We evaluated the validity and test-retest reliability of the SUBS in adult primary care patients.

METHODS

Adults aged 18-65 years were enrolled from urban safety net primary care clinics to self-administer the SUBS using touch-screen tablet computers for a test-retest reliability study (n = 54) and a 2-site validation study (n = 586). In the test-retest reliability study, the SUBS was administered twice within a 2-week period. In the validation study, the SUBS was compared with reference standard measures, including self-reported measures and oral fluid drug tests. We measured test-retest reliability and diagnostic accuracy of the SUBS for detection of unhealthy use and substance use disorder for tobacco, alcohol, and drugs (illicit and prescription drug misuse).

RESULTS

Test-retest reliability was good or excellent for each substance class. For detection of unhealthy use, the SUBS had sensitivity and specificity of 97.8% (95% confidence interval [CI], 93.7-99.5) and 95.7% (95% CI, 92.4-97.8), respectively, for tobacco; and 85.2% (95% CI, 79.3-89.9) and 77.0% (95% CI, 72.6-81.1) for alcohol. For unhealthy use of illicit or prescription drugs, sensitivity was 82.5% (95% CI, 75.7-88.0) and specificity 91.1% (95% CI, 87.9-93.6). With respect to identifying a substance use disorder, the SUBS had sensitivity and specificity of 100.0% (95% CI, 92.7-100.0) and 72.1% (95% CI, 67.1-76.8) for tobacco; 93.5% (95% CI, 85.5-97.9) and 64.6% (95% CI, 60.2-68.7) for alcohol; and 85.7% (95% CI, 77.2-92.0) and 82.0% (95% CI, 78.2-85.3) for drugs. Analyses of area under the receiver operating curve (AUC) indicated good discrimination (AUC 0.74-0.97) for all substance classes. Assistance in completing the SUBS was requested by 11% of participants.

CONCLUSIONS

The SUBS was feasible for self-administration and generated valid results in a diverse primary care patient population. The 4-item SUBS can be recommended for primary care settings that are seeking to implement substance use screening.

A comparative review of guides for implementing alcohol screening and brief interventions into trauma and primary care settings

The likelihood that a patient is currently using alcohol is high across all health care settings with almost one in four persons in the United States aged 12 years or over reporting excessive drinking on at least one occasion in the past 30 days. Screening and brief intervention (SBI) is an evidence-based approach to help decrease alcohol-related harm among persons seeking health care. The Centers for Disease Control and Prevention and the Committee on Trauma, American College of Surgeons, have provided guidelines for implementation of an SBI program within a health care organization. This column provides a comparative overview of three of these guides. These guides provide practical information to help nurses and other health care providers with the planning and implementation of alcohol SBI into routine practice.