SBIRT in a Community Health Setting: The Foundation for Integration of Substance Abuse and Behavioral Health Treatment

According to the U.S. Department of Health and Human Services, only 53 percent of people with co-occurring disorders receive services in the substance abuse and mental health service system. However, although large numbers of people with these conditions may not be seen in traditional treatment settings, their disorders may be diagnosed in other settings such as primary care. In response, Access Community Health Network (ACCESS) has instituted the systematic integration of SBIRT within its system serving 215,000 low-income patients each year. Beginning with the creation of a training curriculum for medical residents, ACCESS is now using SBIRT as the basis to create a recovery oriented system that utilizes the community health center as the entry point into a well-coordinated network of services for individuals with co-occurring substance abuse, mental health and health issues. Important to this process has been the creation of a framework for using SBIRT in primary care practice and strategies for reducing stigma. To date, ACCESS has trained 65 residents and practitioners in the use of SBIRT and piloted its use in 3 health centers that serve over 22,000 adult patients per year. Over the course of the next two years, all of ACCESS' 200 plus practitioners will be trained in SBIRT and use it as part of their daily practice. ACCESS' experience in instituting SBIRT throughout a large community health network can provide useful instruction to the primary care community as it seeks to learn new strategies for addressing substance use and behavioral health integration.