Lessons Learned in Integrating Screening, Brief Intervention, and Referral to Treatment Protocols into Primary Care Settings

A growing body of evidence has demonstrated that screening, brief intervention, and referral to treatment (SBIRT) in healthcare settings is effective in creating behavior change and preventing adverse health outcomes attributable to drug and alcohol misuse. However, despite this evidence, screening and brief intervention protocols have not been widely adopted in primary healthcare settings. In order to increase the utilization rate of screening and brief intervention procedures and encourage the development of integrated care systems in primary care clinics across Colorado, including community health centers and private practice offices, SBIRT Colorado piloted three innovative implementation models: 1) evidence-based clinical guideline development and dissemination; 2) pay-per-service reimbursement schedules; and 3) enhanced in-service provider trainings. Valuable lessons have been learned from each model, and the data collected informs decision making around program expansion and funding priorities. Preliminary findings suggest that each model has the potential success depending on the level of staff buy-in and resources available. This presentation explores the obstacles that often hinder the efficacy of SBIRT services in primary healthcare settings, and explores the administrative and policy considerations that are necessary for effective implementation. Recommendations for standardizing screening, brief intervention, and referral to treatment procedures within an integrated healthcare model in primary care practice include: applying a systematic public health approach to screening; providing appropriate training for conducting brief intervention and brief therapy; establishing a reliable referral and follow up process with local mental health and substance use treatment providers; and identifying a “practice champion” to oversee implementation and evaluation.