Efforts to assist patients to change behaviors often fail because the message is narrowly focused and accusatory rather than empowering, or the messenger is not culturally competent. Project ASSERT, funded in 1994 by CSAT to address these problems in the Boston Medical Center (BMC) Emergency Department (ED) employs peer educators to screen a diverse patient population for preventable conditions, and offer information, a motivational intervention, health resources, support and advocacy while respecting patients’ dignity and cultural backgrounds. Of 4,210 patients screened during 8 months in 1999, 1544 had a substance abuse problem; of this group, 40% had no primary care doctor; 70% had a substance related injury; 50% used illicit drugs; 25% were depressed and 39% threatened or afraid. The brief motivational intervention method (TIPS #35) involves an interview in which patients explore the pros and cons of substance use with peer educators and then self-report readiness to change/seek treatment on a scale of 1-10. The mean readiness score for patients not seeking treatment was 6.32 vs. 9.77 for those seeking it (p<.001, CI -3.91, -3.01); readiness scores thus correlate significantly with disposition (referral to treatment); 474 patients were transported to treatment by taxi; 59 were referred to outpatient services, 1057 to NA/AA, 1013 to a Readiness to Change Group, 170 to a psych/social worker, and 111 to a shelter. Only 274 patients refused referral. Combining a peer educator model with brief motivational intervention promotes HP 2010 objective #26-22 to increase screening and referral to treatment from the ED.
Learning Objectives: 1. To explore the opportunity provided by an ED visit for facilitating linkage to substance abuse treatment. 2. To describe results of a brief motivational intervention for substance abuse with a diverse, underserved population of ED patients. 3. To demonstrate the effectiveness of the role of outreach workers in the clinical setting
Keywords: Substance Abuse Treatment, Access to Health Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Boston Medical Center Emergency Department--Project ASSERT
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.