IRETA staff member Dr. Dawn Lindsay shares a manifesto and model project
In early April, I had the opportunity to travel to Newark, Delaware to attend “Addressing Substance Use in the Hospital: Building Bridges to Community Treatment.” I always enjoy conferences (they bring me back to my academic roots) and no matter how many I attend, I never fail to learn something new.
While the one-day conference at Christiana Care Health System was a relatively small and regional gathering of around 50 attendees, it did not fail to deliver. The presentations were enlightening, the breakout sessions were engaging, and the panel discussion, “From a patient’s perspective,” was moving. All in all, an extremely well spent day.
I was delighted to find that Lauren Broyles, PhD, RN, who is based in Pittsburgh and has worked with us at IRETA, was delivering one of the morning presentations. Dr. Broyles, research scientist at Pittsburgh’s VA Center for Health Equity Research and Promotion and an assistant professor at the University of Pittsburgh School of Medicine, has become an important voice for the role of the nurse in Screening, Brief Intervention and Referral to Treatment (SBIRT), particularly in hospitals.
Of the conference, Dr. Broyles said: “It was nice to be back in a venue where people were thinking about addressing substance use in the hospital setting.”
Dr. Broyles has a well-defined vision for how nurses can contribute meaningfully to the conversation, summed up by her self-described “manifesto,” which goes like this:
- I believe in addressing the entire SPECTRUM of alcohol use; having a preventative, health promotion orientation.
- I believe that nurses can be effective agents in changing the conversation about alcohol–that is, how, when, and where we talk about it–with ALL of our patients.
- I believe that nurses’ visible, active engagement in the SBIRT process is critical, regardless of their practice setting, specialty, or patient population.
- I believe that through nurse-delivered SBIRT, we can develop a nursing workforce that is equipped and motivated to actively and collaboratively respond to the spectrum of use, across practice levels, across practice settings.
- I believe that as nurses, we bring distinct assets to changing this conversation and moving SBIRT into routine clinical practice—that we are not just another group to potentially pick up what others CAN’T do, WON’T do, or assert that they simply don’t have TIME to do.
- And finally, I believe that by embracing SBIRT as a part of our practice, supporting genuine workforce development, and actively collaborating—not only in patient care delivery of SBIRT, but in the decisions and processes that support its implementation into our everyday practice settings and routines, we CAN change how people think and talk about alcohol use, prevent alcohol-related harm, and more efficiently identify and manage alcohol use disorders, for ALL of our patients.
Project Engage: A Model
From Dr. Broyles’s perspective, Project Engage is a great working example of “how substance use can be addressed in the inpatient setting and how the provider can then follow the patient through to the community.”
Launched at Wilmington Hospital and now expanded to Christiana Care, Project Engage embeds an outreach coordinator with intervention expertise full-time in the hospital. The coordinator counsels patients with substance abuse problems at their bedside and encourages them to go directly into treatment when they leave the hospital. In this way, Project Engage offers patients help when they need it most and provides a clear pathway directly to treatment. Staff even go so far as to offer patients bus passes or rides to treatment facilities.
The outreach coordinator comes to the hospital through a partnership with a local treatment provider, Brandywine Counseling & Community Services. This is an example of a promising approach to SBIRT: a treatment provider offering SBIRT in a medical setting as part of their prevention services (a northeast Ohio FQHC is doing the same thing and seeing success).
At the conference, Terry Horton, M.D., chief of Christiana Care’s Division of Addiction Medicine and medical director for Project Engage, delivered a presentation highlighting the initiative’s positive outcome data so far. Between 2008 (when the project began) and November 2012, more than 1,000 patients have participated and about 30 percent of them followed through with treatment.
“Many of these patients cycle repeatedly in and out of the hospital or the Emergency Department,” Horton said in an article on the project’s website. “We are encouraged by the success we have had in both reducing patients’ suffering, as well as their health care costs.”
In 2011, David K. Mineta, Deputy Director of the White House Office of National Drug Control Programs (ONDCP), visited Christiana Care and praised the model.
“What makes Project Engage so interesting,” said Mineta, “is there’s a research piece, a financing piece, a provider piece, and a [state] government piece. It’s unusual to see all these pieces in one place integrating substance use care with primary care.”
For me, Project Engage points to an important insight about transforming systems of care, and specifically implementing SBIRT in hospital systems: that sometimes it’s not about the grant funding (Project Engage began as a pilot project with minimal funding), but rather about the commitment, creativity, and passion of key people within an organization.
Dr. Dawn Lindsay joined IRETA in April 2011. She completed her graduate work in clinical psychology at the University of Cincinnati in 2002 and was on the faculty in the Department of Psychiatry at the University of Pittsburgh before coming to IRETA. She has eight years of experience conducting NIDA- and NIAAA-funded research in the area of adolescent substance use disorders. She is a member of the American Psychological Association and the American Evaluation Association. Click here for a list of her publications.