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APHA Scientific Session and Event Listing

Danielle A. Lawrence, MPH¹, Amy Graczyk, MA, RN², William Brownsberger, JD¹, Carl Brownsberger, MD¹, William Graham, HPA³, Judith Headley, HPA⁴, David Rosenbloom, PhD⁵, Edward Bernstein, MD¹, and Judith Bernstein, PhD, RNC¹. (1) Youth Alcohol Prevention Center, Boston University School of Public Health, 715 Albany St., Boston, MA 02118, 617-414-8438, dlawrenc@bu.edu, (2) Maternal and Child Health Department, Boston University School of Public Health, 715 Albany St., Boston, MA 02118, (3) Project ASSERT, Boston Medical Center, 818 Harrison St., Boston, MA 02118, (4) Project SAFE, Boston Medical Center, 818 Harrison St., Boston, MA 02118, (5) Joint Together, Boston University, 1 Appleton Street, 4th Floor, Boston, MA 02116

Background: Screening, Brief Intervention, and Referral to Treatment (SBIRT) in primary care settings reduces substance use and associated consequences. Despite a high rate of substance abuse among criminal offenders and interest in mandatory treatment, voluntary screening and intervention have not been tested for feasibility in a courtroom setting. Objective: To investigate the feasibility of SBIRT in a courtroom setting among adults charged with a minor criminal offense. Methods: Judges referred eligible persons (cases dismissed prior to arraignment) for participation in on-site SBIRT. Research assistants approached defendants as they left the courtroom, provided information about the study and the option of speaking with a peer trained in brief motivational intervention--the Health Promotion Advocate or HPA. Those who agreed to participate were escorted to a private office on the premises, where the HPA screened using NIAAA at-risk drinking screening guidelines and questions about use of heroin, cocaine and marijuana, and provided brief intervention and confidential referral when appropriate. Results: Among 725 cases heard by judges during the study period (9-12/05), 59 (8%) eligibles were referred, and 31 (56% of eligibles) arrived at the HPA office. Screening detected 7 positives, with 1 person referred to treatment. Conclusion: Voluntary SBIRT could be effective in reducing substance abuse among individuals involved with the criminal justice system. Support from courtroom staff at all levels, including judges, clerks, court officers, and lawyers, is key to feasibility. However, even a busy courtroom may lack sufficient volume for cost-effectiveness if eligibility is limited to participants with dismissed cases.

Learning Objectives: At the conclusion of the session, the participant will be able to

• Describe a model for rapid screening and brief intervention to reduce substance abuse and associated consequences.
• Identify three challenges to feasibility of voluntary screening and brief motivation (SBIRT)in a district court setting.
• Describe results of SBIRT implementation with persons whose cases were dismissed prior to arraignment.

Keywords: Substance Abuse Prevention, Criminal Justice

Presenting author's disclosure statement:

Not Answered