Screening and Brief Intervention in a Mental Health Clinic: Public Health Agenda or Mental Health Therapy?

The development and dissemination of screening and brief intervention (SBI) technologies for substance abuse have burgeoned in the past decade due to international initiatives led by the World Health Organization and the United Nations Drug Control Program, and U.S. efforts by NIAAA and SAMHSA. While the benefits of SBI for reducing alcohol and tobacco use are well-established, few reports have emerged that describe how clinicians implement SBI technologies in general medical clinics and other community settings. The diffusion of SBI in primary care settings has been described by researchers with the World Health Organization as “difficult business.” The benefits and challenges of doing SBI in alternative settings, such as mental health clinics, have been unexplored. This presentation will describe the UCLA Access to Care project, which has integrated the Alcohol, Smoking, and Substance Use Involvement Screening Tool (ASSIST) and brief intervention into routine care at the university counseling center. To evaluate the implementation process, the project tracked the number of positive screens and ASSISTs administered, conducted qualitative interviews with staff and administrators, and participated in staff meetings. This presentation will describe the screening and brief intervention program and examine the implementation process using the diffusion of innovations conceptual framework by Klein and Sorra (1996). Preliminary findings suggest that the ASSIST is a useful tool for screening college students; however, more work is needed to reduce the time of administration and to address problems of “fit” between the ASSIST and the professional orientations of mental health clinicians.