Presentation Objectives: 1) Define SBIRT and identify components of this evidence-based intervention for identifying, reducing, & preventing problematic use, abuse & dependence on alcohol & illicit drugs 2) Learn how to use the all the components of the SBIRT app, including, but not limited to the screening, brief interventions & referral to treatment features included in this app 3) Recognize the critical need for more research related to occupational therapy intervention and SBIRT, as well as potential obstacles to implementation of SBIRT in treatment settings & resources for continuing education on this topic.

1. Concepts in Technology for Health Professionals

2. Lesson Objectives
•Define SBIRT and identify components of this
evidence-based intervention for identifying, reducing,
& preventing problematic use, abuse & dependence on
alcohol & illicit drugs
• Learn how to use the all the components of the SBIRT app,
including, but not limited to the screening, brief
interventions & referral to treatment features included in
this app
• Recognize the critical need for more research related
to occupational therapy intervention and SBIRT, as
well as potential obstacles to implementation of SBIRT
in treatment settings & resources for continuing education
on this topic.

3. Lesson Objective 1
Define SBIRT:
•Screening
•Brief Interventions
•Referral to Treatment
SBIRT is an evidence-based intervention practice for
identifying, reducing & preventing problematic use, abuse &
dependence on alcohol & illicit drugs
Madras BK, Compton WM, Avula, D et al., 2009

4. Historical Background of the SBIRT Initiative
In 2001, the Institute of Medicine’s Committee on the
Quality of Health Care in America released Crossing
the Quality Chasm: A New Health System for the 21st
Century:
•Identified in this report was the need for community-
based screening for health risk behaviors including
substance use with appropriate assessment and referral
activities
•The SBIRT model was specifically cited as a promising
practice in this report Institute of Medicine, 2001

5. The Goal of the SBIRT Initiative
Reflecting the public health model of
intervention, SBIRT is intended to:
• Prevent the unhealthy
consequences of alcohol and
drug use among those whose
use may not have reached the
diagnostic level of a substance
use disorder
•Help those with the disease of
addiction enter and stay with
treatment. SAMHSA-HRSA, nd

6. Where are SBIRT programs?
•Typically, SBIRT is conducted in medical settings,
including community health centers
•SBIRT has been proven successful in hospitals,
specialty medical practices such as HIV/STD clinics,
emergency departments, and workplace wellness
programs such as Employee Assistance Programs SAMHSA-HRSA

7. Why SBIRT?
SBIRT Decreases Healthcare Costs
Substance misuse & abuse is a significant factor in poor health outcomes and preventable
healthcare costs
• Societal cost of $600 billion annually
• One study estimated the net value of SBIRT adoption was $771 per employee
SBIRT Reduces Severity of substance misuse
• Screening and brief intervention was the single most effective treatment method of
the more than 40 treatment approaches studied, particularly among groups of
people not actively seeking treatment
SBIRT Diminishes Risk of Physical Trauma to patients who go without
specialized substance use treatment
• Studies on brief intervention identified outcomes such as patients’: reducing their alcohol
intake, successful referral to & participation in treatment programs & decreases in
repeat injuries and injury hospitalizations
Following a U.S. Preventive Services Task Force recommendation, in 2011 Medicare began
reimbursing alcohol and screening & counseling in the primary care setting Open Cancer Network (2017); SBIRT (nd)

8. Why OT Should Be Implementing SBIRT
OT is intended to be a holistic, client-centered practice which
addresses the needs of the whole client (Law, Baum & Dunn, 2005)
OT takes place in settings where SBIRT was intended
As direct service providers, OT practitioners occupy a place of trust in
the patient care continuum (Birkhauer, et al., 2017)
Occupational therapy practitioners possess mental health skills and
knowledge as core components of their educational background (AOTA, 2014)
Occupational therapists are skillful evaluators of patient needs, trained
to collaborate with the client for the development of meaningful goals
& outcomes of treatment (Law, Baum & Dunn, 2005)
= SBIRT IS GOOD OT!!

9. Lesson Objective 2
Learn how to use the all the components of the SBIRT app, including:
Screening
•
Brief interventions
Referral to treatment

10. Download the OHN SBIRT app from Open Cancer Network

11. PART 1:
THE BASICS
Click on “Review”:
This opens to a
menu of
SBIRT Basics,
including helpful
information on:
• The Epidemiology of Drug & Alcohol abuse
• Drugs of abuse
• Consequences of Drug & Alcohol Abuse
• A brief explanation of SBIRT & its value
• Graphic illustrations and information regarding risky use

12. PART 2 APPLY: SCREENING
If the patient answers yes to the one question screen, the assessment continues to
a more comprehensive tool, the 3-question AUDIT-C or 10-question AUDIT (for
alcohol use in adults), the DAST (for adult drug use) or the CRAFFT, which screens
for drug and alcohol use by adolescents

13. PART 2 APPLY: BRIEF INTERVENTIONS
Brief interventions are typically provided to patients with less severe alcohol or
substance use problems who do NOT need a referral to additional treatment.
In addition to behavioral health professionals, medical personnel, including OTs
can conduct these interventions and need only minimal training

14. PART 2 APPLY: REFERRAL TO TREATMENT
The referral to treatment process consists of helping patients access specialized
treatment, selecting treatment facilities, and facilitating the navigation of any
barriers that might prevent them from receiving treatment at a specialty setting

15. Lesson Objective 3
•Learn about resources for continuing education
on this topic.
•Identify potential obstacles to implementation
of SBIRT in treatment settings
•Recognize the critical need for more research
related to occupational therapy intervention
and SBIRT

16. RESOURCES: You can receive a free training in SBIRT from the
SAMHSA website or by following the link to the training
here: http://www.integration.samhsa.gov/clinical-practice/SBIRT#bmb=1 …

17. Obstacle 1: Barriers to Reimbursement
Coding and billing policies are essential to widespread use of SBIRT.
• The good news is that reimbursement is available through
commercial insurance, Current Procedural Terminology (CPT) codes,
Medicare G codes, and Medicaid Healthcare Common Procedure
Coding System (HCPCS) codes
• The bad news is that while Medicare currently pays for screening
and brief intervention as preventive services in the primary care
setting, many states have not yet “activated” Medicaid codes for
SBIRT reimbursement.
• More information on SBIRT billing codes may be found through the Institute
for Research, Education &Training, Institute in Addictions, CMS and the
SAMHSA-HRSA Center for Integrated Health Solutions (SAMHSA-HRSA, ND)

18. Obstacle 2: Workflow
One common barrier to implementing SBIRT in primary care
settings is the additional time the practice will add to already
short visits.
• Successful programs employ a multi-disciplinary change
team to identify which existing clinical and administrative
staff will be responsible for various SBIRT functions.
•The keys to successful implementation have included
collaboration with health staff to tailor SBIRT to existing
infrastructure and resources, ongoing training, data
collection for quality monitoring, and process revision
based on results.
•Visit SAMHSA-HRSA Center for Integrated Health Solutions
for resources that address workflow issues (SAMHSA-HRSA)

19. YOUR TAKE AWAY TODAY: SBIRT NEEDS YOU!
There is a critical need for more research related to occupational
therapy intervention & SBIRT
• There are currently NO studies to date on the use and
implementation of SBIRT by occupational therapists
• Nurses and social workers are once again gaining an edge in primary
care settings by providing another revenue-generating service for
their facilities
• Occupational therapists are missing out on an effective, evidence-
based preventive intervention that will make use of our mental
health skills and knowledge and increase our opportunity to deliver
care that is truly client-centered

21. References
American Occupational Therapy Association (2010). Specialized knowledge and skills in mental health promotion, prevention,
and intervention in occupational therapy practice. American Journal of Occupational Therapy, 64:S30-S43.
Birkhäuer, J., Gaab, J., Kossowsky, J., Hasler, S., Krummenacher, P., Werner, C. & Gerger, H. (2017) Trust in the health care
professional and health outcome: A meta-analysis. PLOS One. Retrieved from:
https://doi.org/10.1371/journal.pone.0170988
George Washington University Medical Center. Ensuring Solutions to Alcohol Problems (2008). The promise of the new
reimbursement codes. Retrieved from:
www.ensuringsolutions.org/moreresources/moreresources_show.htm?doc_id=67293
Law, M, Baum, C, & Dunn, W. (2005). Measuring occupational performance: Supporting best practice in occupational therapy.
Thorofare, NJ: Slack, Incorporated.
Madras BK, Compton WM, Avula D et al. (2009). Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and
alcohol use at multiple healthcare sites: Comparison at intake and six months later. Drug and Alcohol Dependence;
280‐295.
Institute of Medicine (2001). Committee on Quality of Health Care in America (IOM). Crossing the quality chasm: A new health
system for the 21st century. Washington, DC.
OHN SBIRT. Open Cancer Network (2017). [Mobile application software]. Retrieved from http://itunes.apple.com
Quanbeck A, Lang K, Enami K, & Brown RL. (2010). A cost-benefit analysis of Wisconsin's screening, brief intervention,
and referral to treatment program: adding the employer's perspective. State Medical Society of Wisconsin, 109(1):9-14
SAMHSA-HRSA (n.d.) In SBIRT: Screening, brief intervention, and referral to treatment: Opportunities for implementation and
points for consideration. Retrieved from: https://www.integration.samhsa.gov/SBIRT_Issue_Brief.pdf