IRETA asks local educators and faith leaders: “How could SBIRT help you?”

On October 4, in conjunction with Gateway Rehab, Waynesburg University, and the Pittsburgh Theological Seminary, IRETA hosted a day-long conference titled “Screening, Brief Intervention and Referral to Treatment for Educators and Faith-Based Organizations.”  The training was designed to educate and inform participants about the SBIRT model and–at least as importantly–to consult with the audience about implementation opportunities in their settings.

SBIRT is an evidence-based practice used to identify, reduce and prevent problematic substance use.  While it may be adapted for use in many settings, primary care and emergency medical settings have thus far received more attention than other community-based environments like schools and churches.  As the National SBIRT ATTC, IRETA works to advance SBIRT to realize its full potential impact on the health of Americans.

Introduction to SBIRT

Geneva Sanford, MSW, LSW, LICDC led the morning session, titled “Introduction to SBIRT.”

But before she said a word about SBIRT, she handed out a worksheet filled with…brain teasers?

Remember these?

Playing with paradigms
Image: scribd.com

“This game is called Paradigms,” she announced, and encouraged participants to work together to solve the puzzles.

These brain teasers, Sanford explained, are about creating that “aha moment.”  You don’t see the answer–and then suddenly you do.

This, she said, is quite often what happens with the patients she sees in her job as a Substance Abuse Coordinator at Grant Trauma Center in Columbus, Ohio.  The connections between substance abuse and its consequences become clear.  Accidents, violence, other health problems.  Troubled relationships, stress.

Using SBIRT, Sanford probes these issues in the context of an informative, motivational conversation about substance use that doesn’t take a hard line about what a patient should and shouldn’t do, but rather elicits information and explores options.

“Put a star next to this slide; this is an important one,” she told the group.

According to the 2011 National  Survey on Drug Use and Health (NSDUH):

recovery samhsa

She paused and asked the audience to consider the 95.3% who do not feel they need treatment. While inadequate treatment access is a major problem, so too is the widespread misperception that substance abuse “is not a problem for me.”  To further illustrate her point, Sanford shared a CDC video about binge drinking.

According to the video:

  • Binge drinking is responsible for a large proportion of alcohol-related harms: “88% of impaired driving events are caused by binge drinkers” andBinge drinking is associated with over half of the 79,000 alcohol associated deaths that are estimated to occur in the US each year”
  • Binge drinkers don’t tend to look like troublemakers: “About 70% of the 1.5 billion episodes of binge drinking that occur annually in the US involve people who are 26  years of age and older” andBinge drinkers most commonly make over $50,000 a year”
  • The major takeaway: “The majority of alcohol problems are caused by people who think they are not problem drinkers”

For many people, connecting these problems with substance abuse is like staring at a brain teaser, not yet able to see the meaning in it.

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The goal of the morning session was to introduce the SBIRT model, available screening tools, and basic components of brief interventions, including Motivational Interviewing.

Throughout her presentation, Sanford emphasized the exploratory nature of the training.  It presented a model that has been successful in many contexts and asked the faith leaders and educators in the audience: How could this help you?

For example, she observed that addiction has historically been perceived as a moral issue.  This might, in fact, be advantageous for the use of SBIRT in a faith setting: people go to faith leaders to discuss moral issues, she said.

Debby Fye, D&A Prevention Supervisor at Mercer County Behavioral Health Commission, pointed to Pennsylvania’s Student Assistance Program (SAP) as an existing asset within educational venues with which SBIRT could be a natural fit.  State mandate requires that each county in Pennsylvania have a SAP team, a referral service for school students modeled off of Employee Assistance Programs.

No matter how well-suited the setting, said Sanford, implementing SBIRT is not for the faint of heart:

“When you implement SBIRT, you’re taking a conversation that has historically been had in treatment centers out into the community.  People may be shocked that you’re asking these questions.  But it’s good that you’re asking these questions.”

Faith Leaders Discuss SBIRT

The afternoon featured breakout discussion groups specific to faith leaders and educators.

Reverend Dr. James Simms, Chairman of IRETA’s Board of Directors, and IRETA Project Associate Jim Aiello co-facilitated the faith leaders’ group.

Simms has substantial experience implementing SBIRT in pastoral settings, having coordinated the Caring Congregation Network (CCN) project in Pittsburgh’s East End between 2004 and 2006.

CCN began when Pittsburgh was chosen to receive technical assistance from the Office of National Drug Policy Control (ONDCP) as part of its 25 Cities Initiative, which was designed to help communities coordinate efforts and resources to prevent substance abuse.  With additional funding from the Kingsley Association and training from IRETA, Simms was able to create and implement an SBIRT program among five predominantly African American churches in Pittsburgh’s East End.

The CCN was an innovative, complex project whose effects persist today.

As he recounted his experiences, Simms offered these insights:

  • On selling the program: “The pervasive use of alcohol and drugs in our community was a good starting point because we knew everyone was touched.”
  • On garnering support:  St. Paul’s (where Simms is minister) has a public health ministry, which Simms leveraged to create the CCN.  “We wanted to address health disparities in the African American community by doing grassroots-level education, so we created a public health ministry.  When SBIRT came along, we were already kind of there.” Simms also targeted faith leaders with whom he has strong relationships.  “I handpicked the churches I wanted to work with because I really didn’t have time to go with anybody who wasn’t ready, who had to be sold.” 
  • On introducing SBIRT training:  “We started with education about addiction as a disease,” he said.  “To make sure we were all on the same page.  It’s not uncommon for churches to think of addiction as a moral issue, that addicts are sinners, and to let God deal with them.”
  • On learning as they went:  Early on, the CCN was having trouble with referrals.  “People weren’t showing up.  Then IRETA came in and gave us a big speech about warm handoffs.” He and others members of the CCN started driving to parishioners’ houses, picking them up and taking them to appointments.

Aiello, a longtime SBIRT trainer for IRETA, explained that SBIRT is a strategy to generate motivation and encourage behavior change in the long run–not necessarily right away. Faith-based settings can be particularly good places to provide support on an ongoing basis, wherever an individual falls on the readiness to change scale.

A person “might still be using, but that doesn’t mean that that moment in time has not been instrumental,” said Sanford.

“You don’t control the whole board,” Aiello told the faith leaders in attendance.  “When you’re playing chess, you don’t get to control the other guy’s pieces.”

John Vaught, lead pastor at the Hills Church in Pittsburgh’s South Hills, thought that SBIRT was a good fit with his role in the church and the expectations of his congregation.

“People are specifically looking for help dealing with life issues,” he said. “That’s often why they’re in the church.”

Simms put it even more bluntly.  “The business of the church is change.  It’s just what happens in church.  Because everybody is a former something in church.”

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Recommended Resources

Core Competencies for Clergy and Other Pastoral Ministers in Addressing Alcohol and Drug Dependence and the Impact on Family Members (2003)

Geneva Sanford’s PowerPoint Presentation

Webinar led by Geneva Sanford on TheIRETAChannel: “Referral to Treatment, Part I” (2013)

Webinar led by Geneva Sanford on TheIRETAChannel: “Referral to Treatment Part II” (2013)