Do hospital emergency deparatment SBIRT programs affect substance abuse treatment initiation? Evidence from Washington State

In 2003 the Substance Abuse and Mental Health Services Administration (SAMHSA) established a major initiative to support the development of screening, brief intervention, and referral to treatment (SBIRT) programs. Washington State received an initial SBIRT grant to develop SBIRT programs in 9 hospital emergency departments (ED), located in 6 counties that accounted for the majority of the state's population. A major objective of the SBIRT program was to promote referral to substance abuse (SA) treatment. The AUDIT and DAST-10 screening tools were used to identify ED patients in need of a brief intervention, and possibly SA treatment. We evaluated the effect of the Washington State SBIRT program on admission to SA treatment for 3 different groups of welfare clients on Medicaid: (1) working age disabled clients enrolled in the aged, blind or disabled (ABD) program (N=2,519), (2) clients on general assistance (N=782), and (3) clients on Temporary Assistance to Needy Families (TANF) (N=3,800). We used propensity score techniques to construct 1:1 matched comparison groups that accounted for the need for SA treatment. Using logistic regression, we evaluated the effect of SBIRT hospital ED programs on admission to SA treatment (outpatient and residential treatment) over a 90-day period following SBIRT screening. The estimated odds ratios, representing the likelihood of being admitted to SA treatment, ranged from 2.4 (p < .001) to 3.2 (p < .001). Our findings suggest SBIRT programs established in hospital EDs can have an important effect in promoting admission to SA treatment for at risk patients.