Screening, Brief Intervention, and Referral to Treatment (SBIRT)
What is SBIRT?
Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a comprehensive integrated public health approach to the delivery of early intervention and treatment services for people with substance use disorders as well as those who are at risk for developing those disorders.
It consists of three major components:
Screening: Assess the patient for risky substance use behaviors using a standardized screening measure (typically the AUDIT, ASSIST, or DAST).
Brief Intervention: Engage a patient showing signs of risky use in a short conversation about their use, using motivational techniques to provide feedback and enhance motivation for change.
Referral to Treatment: For those identified as possibly dependent on a substance or needing additional services, offer information on how to access treatment.
SBIRT is designed for use by providers who don’t specialize in SUD treatment and can be offered in any public health, medical, or related setting, including emergency departments, primary care physicians’ offices, community clinics, and even schools/universities.
Is SBIRT Effective?
A recent study (Babor, Del Boca & Bray, 2017) of over one million people who were screened for drug and alcohol use disorders over a 5-year period evaluated the effectiveness of SBIRT in a variety of medical and community settings.
The study, funded by SAMHSA, found SBIRT to be an innovative and effective way to integrate the management of substance use disorders into primary care and general medicine. Substantial numbers of patients received recommendations for intervention or treatment, with greater intervention intensity associated with larger decreases in substance use.
Patients receiving SBIRT demonstrated significant reductions in substance use, with some caveats that raise questions about the best ways to implement SBIRT as a public health program. It was also associated with improvements in treatment system equity (the provision of care to patients varying in economic status, race/ethnicity, and setting) and efficiency, and found to be cost-effective, too.
Find more research on SBIRT in PubMed, the database for the U.S. National Library of Medicine.
Babor TF, Del Boca F, Bray JW. Screening, Brief Intervention and Referral to Treatment: Implications of SAMHSA’s SBIRT initiative for substance abuse policy and practice. Addiction 2017;112(Suppl. 2): 110-117. http://dx.doi.org/10.1111/add.13675
Looking for SBIRT Training or Technical Assistance?
The Northwest ATTC offers a range of SBIRT training and technical assistance (TA) services to health care organizations. The SBIRT services described below may be offered individually or as part of a training/TA package.
If you are interested in SBIRT training or technical assistance please contact us at [email protected].
SBIRT Basic Training
This 4-hour basic SBIRT training is designed to provide potential SBIRT providers and billers (primary care, emergency department, and behavioral health) with an overview of the background and rationale for SBIRT, along with the details for providing screening, brief interventions, and referral to treatment. The training consists of four modules:
- SBIRT Overview & Rationale – reviews SBIRT’s key components, evidence base, goals, and the target population for services
- Screening – reviews the pre-screen questions, full screens (AUDIT/DAST), screening protocols, clinic workflow examples, and matching interventions to the three levels of risk
- Delivering a Brief Intervention – presents the four-step Brief Negotiated Interview model and provides participants with demonstrations and opportunities to engage in role-play
- Referral to Treatment & SBIRT Billing – reviews the key steps for making an effective referral for individuals at high risk of having a substance use disorder. SBIRT billing requirements are discussed along with important steps for implementation
- Meets the 4-hour training requirement for certification from the WA State Health Care Authority to submit billing for SBIRT and provide or supervise individuals providing SBIRT services
SBIRT Training of Trainers
The Northwest ATTC offers SBIRT Training of Trainers for large organizations and health care systems interested in developing in-house capacity to provide the standardized SBIRT training curriculum. The goal of this two-day training course is to prepare trainers with the knowledge and skills to provide the basic SBIRT training.
During day one of this training, participants will review the SBIRT training curriculum along with materials and discuss strategies to engage trainees and prepare them to deliver SBIRT services. During day two, participants will prepare for and practice teaching small portions of the SBIRT curriculum and receive feedback from the master SBIRT trainers and other TOT participants.
At the end of this training, participants will be able to:
- Introduce SBIRT as a public health approach,
- Explain the rationale and evidence for SBIRT,
- Describe and teach the screening process,
- Outline the goals of conducting a brief interview,
- Teach a four-step Brief Negotiated Interview,
- Describe best practices for facilitating a referral to treatment,
- Conduct teach-backs of various models of the training curriculum.
SBIRT Implementation Intensive Technical Assistance
Training is just one component of adopting and implementing the SBIRT process. The Northwest ATTC provides intensive technical assistance (TA) to clinics, emergency departments, and mental health organizations to assist them with SBIRT implementation.
SBIRT intensive technical assistance services are designed to support health care organizations implement SBIRT services through providing:
- On-site SBIRT training for specific role groups (i.e., medical assistants, front desk staff, providers, and behavioral health consultants)
- Consultation on SBIRT implementation and sustainability practices
- Consultation on effective clinic workflow and integrating SBIRT into the clinic's EMR system
- On-going coaching to ensure SBIRT fidelity
The exact package is customized to meet the needs of the organization requesting training and implementation support.
If you are interested in SBIRT training or technical assistance please contact us at [email protected]
Additional SBIRT Resources
- Substance Use in Adults and Adolescents: Screening, Brief Intervention and Referral to Treatment (SBIRT)
Funded by SAMHSA, this 2 hour online training addresses the basic principles of SBIRT, including how to code and receive reimbursement for SBIRT delivery. It is intended for primary care physicians, pediatricians, psychiatrists, emergency physicians, dentists, chiropractors, social workers, nurses, nurse practitioners, and physician assistants. 1.75 AMA PRA Category 1 credits available (as well as contact hours for other providers).
- SBIRT: Screening, Brief Intervention, and Referral to Treatment
SAMHSA-HRSA Center for Integrated Health Solutions’ SBIRT page links to a wide range of resources related to SBIRT, including training and implementation materials, webinars, apps for implementation support, literature reviews, and more.
- SBIRT Toolkit
This Institute for Research, Education, & Training in Addictions (IRETA) toolkit is designed for practitioners and organizations who are using (or considering the use of) SBIRT in a variety of settings. Includes brochures for clients, and resources to assist with implementation and delivery of SBIRT to adults and adolescents.
- ATTC National Center on Screening, Brief Intervention & Referral to Treatment
Though this center is no longer receiving funding, the website continues to offer a number of useful resources, including the National Registry of SBIRT Trainers, webinars, training-of-trainers curricula, case studies, and more.
- Find all ATTC-developed resources on SBIRT
Includes brochures, web sites, online courses, curricula, videos, and more.
- SBIRT Oregon
This site from Oregon Health & Science University (OHSU) offers clinical tools for implementing SBIRT, along with several video demonstrations of Brief Interventions. It also provides copies of the DAST and AUDIT screening tools in multiple languages.
- UMKC SBIRT
This University of Missouri-Kansas City site includes demonstrations of brief interventions and offers clinical tools for delivering SBIRT services.
- Implementing Care for Alcohol & Other Drug Use in Medical Settings: An Extension of SBIRT
From the National Council for Behavioral Health
- Improving Adolescent Health: Facilitating Change for Excellence in SBIRT
From the National Council for Behavioral Health
- The Big Initiative: SBIRT Education
A learning collaborative hosted by NORC at the University of Chicago