More Acronyms: MI & SBIRT All You Need to Know

Pam Pietruszewski, MA Integrated Health Consultant

National Council for Behavioral Health May 17, 2018

Partnership with: NYS Council for Community Behavioral Health

NY Care Coordination Program The Center for Practice Innovations The Coalition of Behavioral Health

The National Council

• New Registrations Supervisors should contact ruthcw@nyaprs.org to register new staff.

• Missed a Training? Recorded webinars at: cmit.nyaprs.org

• Attendance If you are watching as a group please list everyone’s name on the evaluation form. Additionally, we ask that you forward the link to the evaluation to everyone in attendance.

• CEU’s Social Work CRCC & CPRP let us know in your evaluation form 10 CE hours at the

Pam Pietruszewski, MA Integrated Health Consultant

National Council for Behavioral Health

Pam Pietruszewski is an integrated health consultant for the National Council’s Screening, Brief Intervention and Referral to Treatment (SBIRT) and Motivational Interviewing (MI) product lines. Since 2011, she has been an MI trainer, reaching more than 2200 community behavioral health providers, primary care physicians, nurses, social workers, peers, care managers, medical assistants, therapists and health educators. She completed advanced MI training in 2013 with MI co-founder Bill Miller, Ph.D. and researcher Teresa Moyers, Ph.D. Since 2013, Pam has led SBIRT implementation projects around the country and currently she is faculty on the Achieving SBIRT Practice Transformation change package funded by SAMHSA and the Facilitating Change for Excellence in SBIRT learning collaborative funded by the Conrad N. Hilton Foundation. She is listed in the National Registry of SBIRT Trainers from the Addiction Technology Transfer Center (ATTC).

Motivational interviewing (MI) is a

collaborative, person-centered, guiding method designed to elicit and strengthen

motivation for change.

Miller & Rollnick, 2012

What is MI?

4 Fundamental Processes

Engaging Focusing

Evoking Planning

The Spirit of MI

Partnership

Evocation

Compassion

Acceptance

OARs: Listening Style that Motivates Change

• Open-Ended Inquiry • Affirmations • Reflections

Open-Ended Inquiry

• Understanding the other’s experience

• Ask for examples & elaboration

• How…What…Tell me…

Closed to Open Instead of Try

1. Are you still following the treatment plan?

Tell me more about the treatment plan and how it looks for you day to day.

2. Don’t you want to see your kids grow up?

What are your goals and what is most important to you?

3. Will you go to the support group?

How would you go about it, if you decided you wanted to try the support group?

Affirmations • Supportive, testaments of character • Genuine, direct reinforcements • Demonstrate understanding

Attributes of Successful Changers

Accepting Adaptable Alert Ambitious Assertive Brave Careful Committed Considerate Creative

Determined Eager Faithful Flexible Focused Forgiving Hopeful Ingenious Mature Open

Patient Persistent Reasonable Reliable Steady Strong Thorough Trusting Truthful Willing

• What you hear, what you observe • Succinct • Not problem solving or advice. • Right now. Not the future.

Reflections

“It’s hard dealing with these voices in my head! I don’t always plan to get high but sometimes it’s the only thing

that seems to help.”

It’s hard to deal with the voices.

You’re don’t always want to get high.

You want to find other ways to manage the voices.

Screening to identify people at-risk for developing substance use disorders. Brief Intervention to raise awareness of risks and consequences, internal motivation for change, and help set healthy lifestyles goals. Referral to Treatment to facilitate access to specialized treatment services and coordinate care between systems for people with higher risk and/or dependence.

14

What is SBIRT?

A Paradigm Shift

• Not looking for addiction • Looking for unhealthy substance use patterns • Looking for opportunities for early intervention • Meeting people where they are

SBIRT Work Flow

Screening

No Use or Low Risk Use

Moderate Risk Use

High Risk Use

Brief Intervention

Referral to Treatment

Follow-up

Reinforce healthy choices

Example Screening Tools

AUDIT

Alcohol Use Disorder Identification Test

Alcohol Adults

DAST

Drug Abuse Screening Test Drugs Adults

ASSIST

Alcohol, Smoking, and Substance Abuse Involvement Screening Test

Alcohol, Drugs, Tobacco

Adults

CRAFFT

Car, Relax, Alone, Forget, Family or Friends, Trouble

Alcohol & Drugs

Adolescents

http://www.integration.samhsa.gov/clinical-practice/sbirt/screening

Using Screening to Indicate Risk Level

Risk level AUDIT Results Low risk 0-7

Hazardous Use 8-15

Harmful Use 16-19

Possible dependence 20-40

Babor, 2016 IJADR

IMMEDIATE RISKS • Motor vehicle crashes • Pedestrian injuries • Drowning • Falls • Intimate partner violence

Depressed mood • Homicide & suicide Unintended

firearm injuries Alcohol poisoning • Unprotected sex (leading to STI’s

& unintended pregnancy) • Assaults • Child abuse & neglect • Property crimes • Fires

LONG-TERM RISKS • Gastric distress • Hypertension • Cardiovascular disease • Permanent liver damage • Cancer • Pancreatitis • Diabetes • Alcoholism • Chronic depression • Neurologic damage • Fetal alcohol spectrum disorders

(which include physical, behavioral, and learning disabilities)

CDC, 2014

Single Occasion Weekly Over Time

Brief Intervention

• To raise a person’s awareness of risks associated with substance use, elicit internal motivation for change, and help set behavior change goals

• A 5-30 minute conversation depending on setting, procedure codes

BI Focus Based on Risk

Low Risk/Abstinence Focus on affirming healthy choices, reinforcing person’s reasons for non-use

Moderate Risk Focus on reduced use and reduced risky behavior

High Risk Focus on achieving commitment to return and accepting treatment

BI Models 2. Brief Negotiated Interview • Raise the Subject • Provide Feedback • Enhance Motivation • Develop a Plan

1. FRAMES

Feedback

Responsibility

Advice

Menu of options

Empathy

Self-efficacy

3. FLO

Feedback

Listen & understand

Options explored

Referral to Treatment A process involving

proactive and collaborative coordination

between SBIRT providers and those providing

substance use disorder treatment to ensure a person has

access to and engages in an appropriate higher level of care regarding the

consequences associated with their substance use.

http://www.integration.samhsa.gov/sbirt/tap33.pdf

Shared decision making about options, other services:

• Medications

• Individual therapy

• Peer support

• Group-based treatment

• No treatment but possible self-management with continued primary care support and monitoring

Management & Follow-Up Monitoring (Referral to Treatment 2.0)

What Happens When SBIRT Sticks

• Replaces less effective screening methods

• Views substance use on a continuum, with biological and behavioral factors

• Improves clinical care

• Transforms culture

• Prepares your organization and workforce for health care changes

Questions & Comments

Thank you! PamP@thenationalcouncil.org

• Motivational Interviewing Network of Trainers www.motivationalinterviewing.org

• National Council for Behavioral Health MI Training www.thenationalcouncil.org/motivationalinterviewing

• Substance Abuse Mental Health Administration (SAMHSA) http://www.samhsa.gov/sbirt

• National Institute on Alcohol Abuse and Alcoholism (NIAAA) http://www.niaaa.nih.gov/

• National Council for Behavioral Health SBIRT Consultation www.thenationalcouncil.org/sbirt

• Miller & Rollnick. Motivational Interviewing, 3rd Edition: Helping People Change (Applications of Motivational Interviewing) 2012.

Thank You!

• Next Activity:

Thursday, May 31st, 2018 at 10:00AM

Actionable Items to Help You Navigate Integrated Care

• Recording – This webinar will be posted on our website within a few days.

• Evaluation – please complete the quick evaluation form that will be emailed to you immediately following this webinar.

• Attendance – We have documented your attendance this morning. If you are watching as a group please list everyone’s name on the evaluation form and also forward them the form.

Ruth Colón-Wagner, LMSW Director of Training &

Development ruthcw@nyaprs.org

http://cmti.nyaprs.org/