SBIRT in Pgh Photo

Editor’s Note: This post is about Screening, Brief Intervention and Referral to Treatment (SBIRT). For an introduction to SBIRT, read this post

Last month’s event, Screening, Brief Intervention and Referral to Treatment: An Interprofessional Conference was not massive, but it was certainly a major undertaking and by many measures, a successful one. Our sincerest thanks to the nearly 150 people from all over the country who spent two days with us talking about SBIRT.

As more than one attendee commented, it was refreshing and energizing to be in the same room with so many different types of people who are invested in the use of SBIRT and interested in sharing their experiences and knowledge. A lot of us spend a lot of time in our “real lives” making the case for SBIRT, so it was fun to put that conversation aside and talk about how to do it well.

Here’s a short highlight reel of information, ideas and resources that came out of the conference, intended for folks who were there in person as well as those who couldn’t make it. If something piques your interest, feel free to contact us directly at info@ireta.org to request more information.

Marijuana: A Practical, On-the-Ground Perspective

SBIRT practitioners are learning as they go in Colorado, said Carolyn Swenson, who works on the state’s SBIRT Colorado Initiative.  Since 2013, when marijuana was legalized in Colorado for recreational use, health professionals, state officials, and regular citizens have faced an ever-growing array of information and misinformation about the health impacts of marijuana use.

The Colorado Department of Public Health and Environment has shown leadership by conducting a scientific literature review of marijuana-related health effects and posting it for all to access. In 2014, the Department published Findings and Recommendations: Monitoring Health Concerns Related to Marijuana in Colorado. This report details efforts to track changes in marijuana use patterns as the result of legalization, as well as trends in unintentional poisonings, ER visits, and other other health issues related to marijuana use.

Colorado will not only be a valuable source of information about the health effects of legal marijuana use, it will also provide practitioners with insight about how to fold marijuana use into the SBIRT process. Although, as Swenson noted, the United States Preventative Services Task Force (USPSTF) has said there is insufficient evidence to balance the benefits and harms of SBIRT for drug use, SBIRT Colorado recommends the use of the following (non-validated) screening question: “How many times have you used marijuana in the past year?” Any answer above zero qualifies as a positive screen and warrants further exploration using a brief intervention.

To aid practitioners, SBIRT Colorado has created a guide to discussing marijuana in screening and brief interventions that addresses the medical use of marijuana, common myths about marijuana use, and the diagnostic criteria for cannabis use disorders.

Standardized Patients Take SBIRT Training to the Next Level

When asked what was most memorable about the conference, several people responded, “The girl who cried!”

A couple points of clarification: she wasn’t actually upset–she was acting. And she also didn’t cry in front of everyone. She was a standardized patient (SP) who cried when her simulated interview was going poorly.

“The patient was supposed to be in a lot of pain and was being screened for risky substance use,” explained IRETA Research Associate Piper Lincoln. “When the clinician acknowledged her pain and told her she would get treated for it, she stayed calm. But when the clinician ignored her pain and only focused on conducting the SBIRT screen, she got worried and upset.”

“I think it really showed the range of emotions and situations that a standardized patient can convey,” said Lincoln.

One of the resounding themes of the conference was the value of using standardized patients in training rather than just role-playing. Used by major medical schools across the country (and in higher demand every day), SPs are healthy individuals trained to portray a real patient, health professional, family member or other individual for the purpose of education. They can help students build rapport, take effective personal and social histories, determine diagnoses, and make other clinical decisions.

Several medical students from our Scaife Medical Student Fellowship attended the conference and explained that standardized patients are important training tools in their schools’ curricula. However, nursing students, social work students, and certainly current health and human service professionals rarely have an opportunity to learn new skills using SPs.

And SBIRT is particularly conducive to the use of SPs. “Standardized patients are highly effective when the learning objectives relate to interpersonal skills,” said Valerie Fulmer, who directs the University of Pittsburgh’s SP program.

Dr. Paul Sacco at the University of Maryland School of Social Work commented that social work students could benefit from the use of SPs to simulate personal interaction. “Our students hear about ‘motivational interviewing’ all the time, everywhere they turn. But they don’t have enough opportunities to practice it,” he said.

“This sounds great for students,” a workshop participant called out. “But I work in a clinic trying to implement SBIRT among nurses. How am I supposed to train them?”

Good point! SPs can be used to train current health professionals on site and can also be incorporated into new employee orientations.

Dive In to our Conference Materials

Looking for more?

All conference materials, includng PowerPoint slideshows and handouts from each presenter, are posted on our website: ireta.org/sbirtconf2015materials