An Ohio treatment center provides SBIRT at an FQHC, a region works cooperatively, and everybody wins
It was 2010 when Doug Wentz first heard the word “SBIRT.”
He’d been volunteering for the Ohio National Guard offering D&A services to men and women returning from Iraq and Afghanistan. He was in a meeting about the behavioral health problems they were seeing among returning veterans.
“And I’m making suggestions based on my prevention background. And then a woman named Geneva Sanford said, ‘You know what, I think we ought to SBIRT these people,’ and I had no idea what she was talking about,” Wentz recalled.
“And as she talked, I thought ‘Gee, this makes sense,’ so Jerry Carter, my executive director, and I took her to lunch.”
That lunch was the beginning of something big for Wentz, something that has continued to grow and evolve. Wentz is the Community Services Director at Neil Kennedy Recovery Clinic in Youngstown, Ohio, a subsidiary of Gateway Rehabilitation Center. He’s a Certified Prevention Specialist who’s worked in the field since 1977. His career, he says, has consisted of constantly reinventing himself. This time, it’s Screening, Brief Intervention and Referral to Treatment (SBIRT).
There has been a groundswell of SBIRT activities in northeastern Ohio, a movement that Wentz has helped to stir up and currently includes multiple treatment centers, three sites of one Federally Qualified Health Center (FQHC), an adolescent mental health center, a couple of universities, and a private psychiatry practice. And it’s just getting started.
In the last two years, Wentz and two trainers, Sanford and Kriss Herron of Kettering Hospital, have begun leading trainings and dedicating time to moving SBIRT into practice in various locations in northeastern Ohio. The most prominent of these locations is One Health Ohio, an FQHC located in Youngstown.
“Everybody is seeing that we’re in a crisis. We are losing four Ohioans every day to prescription overdose deaths. 75% to 85% of our patients in our detox beds are opiate addicts and the people we’re seeing are younger and younger.”
There are so many unique aspects to this particular SBIRT movement that it’s hard to point them all out. Perhaps most unique, though, is that much of the SBIRT activity is being funded by a treatment center.
Neil Kennedy receives federal prevention dollars and has dedicated some of them to developing SBIRT programs. Specifically, the agency dedicates prevention funds toward a part-time CPS to do SBIRT at One Health Ohio and a percentage of Wentz’s time developing trainings and overseeing SBIRT projects.
In Ohio, said Wentz, “We obviously want to see the Medicaid codes get turned on. If there’s a payer source, the medical community will do SBIRT. But in the meantime, I think this is really doable [for Neil Kennedy].”
This arrangement is an interesting example of “segregated no more” action on the part of a treatment provider, a model of addiction treatment that Dr. Tom McLellan foretold “the swift, the smart and the flexible” will see great success with in under healthcare reform. As McLellan (among others) pointed out when he worked at the White House, patients need a continuing care model for substance use and that means primary care and addiction treatment providers need to work together.
At One Health Ohio, “working together” means literally working in the same room. They use the “Oregon Model” of clinic flow, which consists of an initial six-question screen that patients complete before the medical intake process. If the patient screens positive, it triggers a second, more specific test to look at whether the patient has the propensity to have alcohol, drug or behaviorally related problems.
The doctor then determines if she will do the intervention personally or refers the patient to Wentz’s staff. If referred, the patient meets with Wentz’s staff person in the morning or a trained FQHC employee in the afternoon. During the meeting, the AUDIT or DAST screen is administered and, if appropriate, brief interventions and referrals to treatment are offered.
Although the project kicked off at One Health Ohio in February of this year, the data already looks encouraging. “The number of people that they’ve identified in the past is way smaller than this, so they feel they’re beginning to make some headway,” said Wentz.
The CEO of One Health Ohio is Dr. Ron Dwinnells, whose enthusiasm has been a major driver for SBIRT’s quick, comprehensive implementation in his clinic. Dwinnells not only oversaw training for his staff members, he also saw an opportunity to research SBIRT’s effectiveness by comparing the identification of substance misuse at his Youngstown clinic with his two other FQHC locations in Alliance and Warren, Ohio. To compare outcomes between the test site and the two control sites, Dwinnells reached out to researchers at Kent State University and Northeastern Ohio College of Medicine, who are assisting in the evaluation of the project.
Of Dwinnells, Wentz said, “He’s a visionary and quickly grasped how important this would be.”
Wentz also pointed out that the partnership with Neil Kennedy offers One Health Ohio a valuable service. With the changes accompanying healthcare reform, he said, “Everybody is courting the FQHCs. In our case, we didn’t want anything from them. We said, ‘We want to give you this program.’ This is a different approach for an SUD provider to take. ‘We don’t want your money. We just want to coordinate with you to improve patient care.’”
Wentz is continuing to offer trainings that FQHC staff can attend, as well as a range of other healthcare providers and community members. Since January 2012, One Health Ohio has conducted three six-hour trainings throughout northeastern Ohio with over 150 professionals in attendance.
These trainings have led to SBIRT implementation in a variety of settings in the region, including a private psychiatric practice, an adolescent mental health clinic, and a for-profit D&A treatment provider. Wentz is happy to help facilitate the process and to learn from the experiences of these other sites.
For example, he led a training for residents working in the dental clinic at St. Elizabeth’s Hospital. Because they use electronic records, the clinic decided to use the NIDAMED online screening tool that integrates with EHRs.
“So we played around with that tool and it was a lot of fun,” said Wentz. “It only takes ten or fifteen minutes to use the whole thing. It’s pretty cool.”
Why are these SBIRT trainings so well attended and why are so many different groups in the region interested in SBIRT and willing to work together to implement it? Wentz offered a couple explanations.
The first is the value placed on relationships in the region. “I have great respect for my professional colleagues across the Mahoning Valley here,” he said. “Everybody kind of knows everyone here. It’s connections, it’s relationships and it’s professional reputations.”
And secondly, “Everybody is seeing that we’re in a crisis. We are losing four Ohioans every day to prescription overdose deaths. 75 to 85 percent of our patients in our detox beds are opiate addicts and the people we’re seeing are younger and younger.”
“We’re all waking up to it and thinking, ‘Jeez, we’ve got to do something. We can’t wait for these people to show up in drug courts or in the federal pen or in an emergency room. We’ve got to do something sooner.’ I think this response is coming from the community—from everybody, including the docs.”
Neil Kennedy is a part of that community, and a part specially equipped with an understanding of substance abuse. The majority of the patients that use the One Health Ohio, of course, don’t need specialty treatment. But some do. And many may benefit from brief interventions, but not need referrals to treatment.
“Ninety-five percent of the patients we screen are not going to be our customers,” Wentz said. “As part of our business model, we obviously do hope to get some referrals, but our business is not just addiction treatment. It’s also prevention. It’s being good citizens in the community.”
As the National SBIRT-ATTC, we will follow this project’s developments and its outcomes. Stay tuned for an update on One Health Ohio, Neil Kennedy and SBIRT in Ohio’s Mahoning Valley on The Institute Blog.