Search

Introduction: A working understanding of referral to treatment is a prerequisite for the modern training registrar. This article set out to ascertain higher specialty trainees' knowledge of the rules and definitions of referral to treatment in otolaryngology in England. Methods: A ten-question survey on the rules and definitions of referral to treatment was distributed to higher specialty trainees in otolaryngology in London, Kent, Surrey, Sussex training deaneries. Results: A total of 30 surveys were collected. Overall knowledge of referral to treatment among higher specialty trainees was poor. The mean score was 3.83/7 (54.7%) and the median was 4/7 (57.1%). Previous training in referral to treatment, in the form of didactic study days, improved survey scores. The three trainees that had this previous teaching in referral to treatment had a mean score of 4.3 (61.9%). Discussion: This article is believed to be the first insight into the working knowledge of referral to treatment among training registrars in the UK. This article has uncovered a potential gap in higher specialty training. Formal training in referral to treatment as part of nationwide higher specialty training should be considered.

To evaluate a screening, brief intervention and referral to treatment curriculum for alcohol and other substance use developed, implemented and integrated into a pediatric residency program.During a 1-month adolescent medicine rotation, pediatric, and medicine/pediatric residents in an urban teaching hospital completed a 2 1/2-hour formal curriculum including a didactic lecture, a 40-minute video describing the Brief Negotiation Interview (BNI), and a skill-based session practicing the BNI and receiving individualized feedback. Access to a website with didactic material was provided. Outcome measures were pre- and post-training knowledge, BNI performance measured with a standardized patient using a validated BNI adherence scale, satisfaction with training, and adoption of BNI into clinical practice.Of the 106 residents trained, 92(87%) completed both pre- and post-test evaluations. Significant improvements were found in pre- versus post-test scores of knowledge, (20.0 [2.4 SD] vs. 24.1 [3.5 SD], p.001) and BNI performance comparing pre- and post BNI adherence scale total scores, (5.14 [1.8 S.D.] vs. 11.5 [.96], p.001). Residents reported high satisfaction with training, [1.4, SD .5, immediately and 1.6, SD .6, 30-days post training)with scores ranging from 1 to 5 with lower score=greater satisfaction. During the 12-month follow-up period, we received 83 responses from residents reporting a total of 129 BNIs in actual clinical settings.A screening, brief intervention and referral to treatment curriculum was successfully integrated into an adolescent medicine elective in a pediatric residency program. Residents demonstrated significant improvements in knowledge and skills performing the BNI, with high satisfaction and adoption of the BNI into clinical practice.

Alcohol, tobacco, marijuana, and other substance use by adolescents can have a serious impact on their health and well-being according to the American Academy of Pediatrics (AAP, 2016). School social workers (SSW) are trained to conduct assessments and interventions with adolescents and families to improve their functioning and academic performance (National Association of Social Workers [NASW], 2003). Also, substance abuse prevention, identification, brief intervention, and referral to treatment are supported by the profession’s standards for working with adolescents (NASW, 2003). For SSW interested in incorporating these services into their work, this practice highlights column describes the importance and principles of conducting adolescent screening, brief intervention, and referral to treatment (SBIRT) for substance use. Highlights are drawn from Substance Use Screening and Intervention Implementation Guide: No Amount of Substance Use Is Safe for Adolescents (hereinafter, AAP Guide), a guide developed through a cooperative agreement between AAP and Centers for Disease Control and Prevention (CDC) (AAP, 2016).

Standardized screening, brief intervention, and referral to treatment (SBIRT) is effective when used by health care professionals to assess, educate, and intervene to address risky alcohol use. To accelerate SBIRT training within academic settings, the Substance Abuse and Mental Health Services Administration funded implementation of its SBIRT curriculum to promote its use by future health care professionals. We report on how SBIRT content was implemented within nursing, social work, psychology, and family medicine residency programs at a state university. The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) evaluation framework was used to compare delivery of SBIRT curriculum across health professions. Survey data measured changes in student knowledge, confidence, and responsibility to use SBIRT for alcohol and drugs, pre- and post-SBIRT training. Twelve months postgraduation follow-up surveys examined maintenance of outcomes and SBIRT use in practice. Observational data explored fidelity and adaptations made to curriculum content and delivery logistics. Results indicated that instructor adoption, fidelity, and format varied across health professional training programs, with adaptations made to improve fit, role alignment, and cultural relevance. Despite variation in curriculum delivery, students demonstrated significant gains in knowledge and confidence, ( p < .001). Key implementation and maintenance challenges included time constraints, instructor buy-in, competing accreditation requirements, and costs for using the university simulation laboratory to practice SBIRT. Strengths supporting maintenance included flexibility to adapt curriculum, department champions, and electronic resources to support curriculum delivery. Results suggest that adaptations maximizing the feasibility and fit of SBIRT within existing courses enhanced its adoption and maintenance potential without sacrificing effectiveness.

Recent developments in alcohol monitoring devices have made it more feasible to use contingency management (CM) procedures to reduce alcohol use. A growing body of literature is demonstrating the effectiveness of CM to reduce alcohol use among community recruited adults wearing transdermal alcohol concentration (TAC) monitoring devices. This article describes the quality improvement process aimed at adapting TAC-informed CM aimed at minimizing alcohol use and maximizing treatment completion. This extends literature to a high-risk population; adults arrested and awaiting trial (pretrial) for criminal charge of driving while intoxicated (DWI). Participants were enrolled during their orientation to pretrial supervision conditions of DWI bond release. At enrollment, participants completed a screening, brief intervention, and referral to treatment; those with high risk alcohol histories were enrolled in an 8-week CM procedure to avoid TAC readings. Four Plan-Do-Study-Act (PDSA) quality improvement cycles were conducted where the TAC cutoff for determining alcohol use, the quantity of reinforcer, and handling of tampers on the transdermal alcohol monitor were manipulated. Across four PDSA cycles, the retention for the full 8-weeks of treatment was increased. The proportion of weeks with alcohol use was not decreased across cycles, the peak TAC values observed during drinking weeks were significantly lower in Cycles 1 and 4 than 3. CM may be developed as a tool for pretrial supervision to be used to increase bond compliance of those arrested for DWI and for others as a method to identify the need for additional judicial services.

Unhealthy substance use is common in primary care populations and is a major contributor to morbidity and mortality. Two key strategies to address unhealthy substance use in primary care are the process of screening, brief intervention, and referral to treatment (SBIRT), and integration of treatment for substance use disorders into primary care. Implementation of SBIRT requires buy-in from practice leaders, careful planning, and staff and primary care provider training. Primary care-based treatment of opioid and alcohol use disorders can be effective; more data are needed to better understand the benefits of these models and identify means of treating other substance use disorders in primary care.

BackgroundProblematic alcohol use is associated with detrimental cognitive, physiological and social consequences. In the emergency department (ED), Screening, Brief Intervention, and Referral to Treatment (SBIRT) is the recommended approach to identify and treat adolescent alcohol-related concerns, but is underused by physicians.ObjectiveThis study examined pediatric emergency physicians’ perceptions of adolescent drinking and treatment, and their current self-reported SBIRT practices.MethodPhysicians in the Pediatric Emergency Research Canada database (n=245) received a 35-item questionnaire that was administered through a web-based platform and paper-based mail-outs. Recruitment followed a modified Dillman four-contact approach.ResultsFrom October 2016 to January 2017, 166 pediatric emergency physicians (46.4% males; mean age=43.6 years) completed the questionnaire. The response rate was 67.8%. Physicians recognized the need (65%) and responsibility (86%) to address adolescent alcohol problems. However, confidence in knowledge and abilities for SBIRT execution was low. Twenty-five percent of physicians reported never having practiced all, or part of, SBIRT while 1.3% reported consistent SBIRT delivery for adolescents with alcohol-related visits. More alcohol education and counselling experience was associated with higher SBIRT use; however, physicians generally reported to have received minimal alcohol training. SBIRT practices were also associated with physician perceptions of problematic alcohol use and its treatability.ConclusionsPediatric emergency physicians acknowledge the need to address problematic adolescent alcohol use, but routine SBIRT use is lacking. Strategies to educate physicians about SBIRT and enhance perceived self-competency may improve SBIRT use. Effectiveness trials to establish SBIRT impact on patient outcomes are also needed.

Screening, Brief Intervention, and Referral to Treatment (S·BI·RT) in pediatric practices normalizes conversationsbetween youth and healthcare providers about alcohol and other substance use, and supports guidance about healthybehaviors. S·BI·RT also identifies youth ages 12-22 whose current use of addictive substances places them at risk fordeveloping substance use disorders, prompting provider brief intervention and referral for further assessment ortreatment before a substance use disorder develops. From May 2014 to June 2017, S·BI·RT was implemented as astandard of care in 23 pediatric practices in three cohorts across 10 organizations in New Hampshire —includingacademic medical centers and FQHCs—serving over 74,000 youth. This case study focuses on strategies associatedwith operationalizing S·BI·RT, specifically training and technical assistance related to clinical workflow, for youth andyoung adults.

OBJECTIVE: Understanding the costs to implement Screening, Brief Intervention, and Referral to Treatment (SBIRT) for adolescent substance use in primary care settings is important for providers in planning for services and for decision makers considering dissemination and widespread implementation of SBIRT. We estimated the start-up costs of two models of SBIRT for adolescents in a multisite U.S. Federally Qualified Health Center (FQHC). In both models, screening was performed by a medical assistant, but models differed on delivery of brief intervention, with brief intervention delivered by a primary care provider in the generalist model and a behavioral health specialist in the specialist model. METHOD: SBIRT was implemented at seven clinics in a multisite, cluster randomized trial. SBIRT implementation costs were calculated using an activity-based costing methodology. Start-up activities were defined as (a) planning activities (e.g., changing existing electronic medical record system and tailoring service delivery protocols); and (b) initial staff training. Data collection instruments were developed to collect staff time spent in start-up activities and quantity of nonlabor resources used. RESULTS: The estimated average costs to implement SBIRT were $5,182 for the specialist model and $3,920 for the generalist model. Planning activities had the greatest impact on costs for both models. Overall, more resources were devoted to planning and training activities in specialist sites, making the specialist model costlier to implement. CONCLUSIONS: The initial investment required to implement SBIRT should not be neglected. The level of resources necessary for initial implementation depends on the delivery model and its integration into current practice.

BACKGROUND: Stigma associated with substance use is considered a barrier to implementing Screening, Brief Intervention, and Referral to Treatment (SBIRT) and assisting patients to receive appropriate treatment. OBJECTIVES: To test the efficacy of SBIRT education and training in changing undergraduate nursing students’ attitudes about working with patients who have problems with alcohol and opioid use. DESIGN: A sample of 49 undergraduate nursing students were surveyed, using five subscales, at three time points. RESULTS: After a 15-week semester that included (a) SBIRT education and (b) weekly clinical experiences with patients who had alcohol use problems the undergraduate nursing students’ stigma decreased as measured by three of the five subscales. The students’ attitudes toward working with patients who had opioid use problems exhibited favorable change as measured by four of the five subscales. CONCLUSION: SBIRT education and training for undergraduate nursing students might help mitigate some of their stigma toward working with patients who have mild to moderate alcohol and opioid use problems.

Background Screening, Brief Intervention, and Referral to Treatment (SBIRT) for substance use is increasingly used in clinical care. Despite its endorsement by several professional societies, the U.S. Preventive Services Task Force has found the evidence base for adolescent SBIRT to be insufficient. A measure of substance use that is brief enough to embed in the electronic medical record could be used in pragmatic trials that enroll large numbers of primary care patients, facilitating research in this area. Methods Participants aged 14–18 years (N = 492) completed an electronic survey that included a 90-day Timeline Follow Back (TLFB) Calendar, considered the criterion standard, along with three survey questions about the frequency of their alcohol use: days of use in the past three months, average days of use per week in the past three months, and average days of use per month in the past year. We calculated the correlation between the number of days reported on each of the three questions and the total number of days of use reported on the TLFB. Results The question on number of days of use in the past three months was highly correlated with alcohol consumption frequency on the 90-day TLFB assessment (rho = 0.903). Other items displayed lower but satisfactory correlation with the TLFB (rho = 0.719−0.830). Conclusions A single question about past 3-month frequency of alcohol use was highly correlated with alcohol use frequency on the criterion standard TLFB among adolescents presenting for routine primary care.

As many as 80% of the nearly five million adults under community supervision (i.e., probation, parole) are substance involved; however, treatment utilization is low. Using a multi-site randomized controlled trial, we tested the efficacy of in-person motivational interviewing (MI), a motivational computer intervention (MAPIT), or standard probation intake (SAU) to encourage treatment initiation among 316 substance-involved probationers in Dallas, Texas and Baltimore City, Maryland. Ninety-three percent (n=295) of participants completed the 2-month follow-up and ninety percent (n=285) completed the 6-month follow-up. At 2-months, individuals in the MAPIT condition were more likely to report treatment initiation compared to the SAU condition (OR=2.40, 95% CI=1.06, 5.47) via intent-to-treat analysis, especially among those completing both sessions (RE=.50, 95% CI=.05, .95) via instrumental variable analysis. At 6-months, MAPIT approached significance for treatment initiation in both analyses. MI did not achieve significance in any model. We did not find any differential impact on substance use. The success of MAPIT suggests that an integrated health-justice computerized intervention as part of a Screening, Brief Intervention, and Referral to Treatment (SBIRT) can be used to address public safety and health issues.

Most nursing programs lack curriculum on substance use. This project evaluated 3 didactic instructional methods for teaching baccalaureate nursing students about screening, brief intervention, and referral to treatment for substance use. In-person, asynchronous narrated slides and interactive online instructional methods were all effective in developing students' competency; however, active learning methods (in-person and interactive online course) were more effective in changing students' attitudes about their role in screening and intervening for drug use.

Emerging Adults (ages 18-25) have the highest prevalence of substance use disorders and rarely receive treatment from the specialty care system. Thus, it is important to have screening instruments specifically developed for emerging adults for use in Screening, Brief Intervention and Referral to Treatment (SBIRT) models. Optimal cutoffs for the widely-used GAIN Short-Screener's (GAIN-SS) Substance Disorder Screener (SDScrY) are not established specifically for emerging adults. Therefore, this study examined the sensitivity and specificity of the SDScrY in predicting emerging adult (ages 18-25) substance use disorders.We analyzed data from emerging adults in a large clinical sample (n=9,808) who completed both the five-item SDScrY (α=0.85) and the full criteria set for DSM-IV Substance Use Disorders. We estimated the sensitivity, specificity and area under the curve to determine optimal cutoffs.Analyses revealed a high correlation between the SDScrY screener and its longer parent scale (r=0.95, p0.001). Sensitivity (83%) and specificity (95%) were highest at a cutoff score of two (AUC=94%) on the SDScrY for any past year substance use disorder. Sensitivity (85%) was also high at a cutoff score of two on the SDScrY for any past year alcohol disorder.The five-item Substance Use Disorder Screener is a sensitive and specific screener for emerging adults, and could be used to identify emerging adults who may benefit from SBIRT interventions.

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based process for identification, prevention, and treatment of alcohol misuse. The purpose of this study was to examine the effects of an alcohol-focused training on first-year MSW students’ (n = 71) knowledge, attitudes, and beliefs about SBIRT. Changes in item means were assessed using repeated-measures analysis of variance (critical α = .002). Data indicated a significant and strong main effect for training; perceived competence improved immediately and remained significantly higher 30 days posttraining. Other improvements included knowing what questions to ask patients, ease making alcohol-related statements, and believing that it is rewarding to work with at-risk patients.

Reducing alcohol misuse is a priority for U.S. health officials considering that misuse of alcohol is a leading preventable cause of morbidity and mortality. Consequently, health centers are integrating Screening, Brief Intervention, and Referral to Treatment (SBIRT) for alcohol misuse within usual care. Although SBIRT is well validated among general patient samples, results have not generalized to drinkers with probable alcohol use disorder; moreover, little is known about the efficacy of SBIRT with patients who are of low-income or ethnic or racial minority status. Members of these groups are of particular concern because they are at risk to experience trauma, potentially in concert with alcohol misuse. Therefore, translational approaches to delivering SBIRT particularly with these groups of interest might be needed to meet the Grand Challenge of reducing alcohol misuse. Accordingly, this study combined SBIRT with a model designed to address psychological trauma: T-SBIRT. With a sample of 112 adults, mo...

A grand challenge for social work is addressing widespread public health problems of alcohol misuse. MSW students (n = 83) received Screening, Brief Intervention, and Referral to Treatment (SBIRT) training through didactic sessions, role plays, and pre–post videotaped standardized patient (SP) interactions. SBIRT knowledge, self-reported practice behaviors, and confidence were assessed at pretest, 30 days, and 6 months posttest. Videos were coded to assess intervention-adherent behaviors. General linear mixed models analyzed changes. Participants demonstrated increased adherence to SBIRT behaviors, and knowledge, skills, and confidence increased posttraining. Findings suggest SBIRT training increases students’ capacity to implement evidence-based interventions designed to reduce alcohol misuse.

Social work education is well positioned for workforce development initiatives that prepare practitioners to use Screening, Brief Intervention, and Referral to Treatment (SBIRT) with people at risk for alcohol use disorders. This article presents preliminary process and outcome evaluation data from the first year of a three-year grant which suggests that the training is acceptable and results in significant changes in trainees’ knowledge, attitudes, and self-perceived SBIRT skills. Training was embedded within the curricula of an urban school of social work, which includes a Bachelor of Social Work (BSW) program and a single-concentration clinical Master of Social Work (MSW). Trainees included social work students (n = 134) and field instructors (n = 38). More than 90% of students were very satisfied or satisfied with the training, and 100% of field instructors rated the training as excellent or good. Students demonstrated significant changes from pre- to posttraining in substance use knowledge, confidenc...

Adverse family conditions, abuse and neglect during childhood present important risk factors for the appearance of emotional and behavioral problems. The main aim of this paper is to describe the presence of these kinds of disorders in children in residential child care and to explore individual, socio-family and care process factors associated with the use of mental health services. The sample consisted of 1216 children 6–18 years old in residential care in several Spanish regions. Information about emotional and behavioral problems was gathered according to two criteria: receiving some kind of treatment services and/or being identified as within the clinical range in the Child Behavior Checklist (CBCL). Results showed that 49% of cases were receiving some kind of mental health treatment and 61% were identified as within the clinical range in some of the broad band scales of the CBCL. In terms of agreement between referral to treatment and CBCL scores, results showed that four out of ten cases identified as within the clinical range were not receiving any kind of treatment. Several factors related to the type of problems detected in the CBCL, personal variables, and child care arrangements are associated with greater use of mental health services.

Aims This paper describes the major findings and public health implications of a cross-site evaluation of a national Screening, Brief Intervention and Referral to Treatment (SBIRT) demonstration program funded by the US Substance Abuse and Mental Health Services Administration (SAMHSA). Methods Eleven multi-site programs in two cohorts of SAMHSA grant recipients were each funded for 5 years to promote the adoption and sustained implementation of SBIRT. The SBIRT cross-site evaluation used a multi-method evaluation design to provide comprehensive information on the processes, outcomes and costs of SBIRT as implemented in a variety of medical and community settings. Findings SBIRT programs in the two evaluated SAMHSA cohorts screened more than 1 million patients/clients. SBIRT implementation was facilitated by committed leadership and the use of substance use specialists, rather than medical generalists, to deliver services. Although the quasi-experimental nature of the outcome evaluation does not permit causal inferences, pre–post differences were clinically meaningful and statistically significant for almost every measure of substance use. Greater intervention intensity was associated with larger decreases in substance use. Both brief intervention and brief treatment were associated with positive outcomes, but brief intervention was more cost-effective for most substances. Sixty-nine (67%) of the original performance sites adapted and redesigned SBIRT service delivery after initial grant funding ended. Four factors influenced SBIRT sustainability: presence of program champions, availability of funding, systemic change and effective management of SBIRT provider challenges. Conclusions The US Substance Abuse and Mental Health Services Administration's Screening, Brief Intervention and Referral to Treatment (SBIRT) demonstration program was adapted successfully to the needs of early identification efforts for hazardous use of alcohol and illicit drugs. SBIRT is an innovative way to integrate the management of substance use disorders into primary care and general medicine. Screening, Brief Intervention and Referral to Treatment implementation was associated with improvements in treatment system equity, efficiency and economy.

From International Network on Brief Interventions for Alcohol and Other Drugs (INEBRIA) Meeting 2013 Rome, Italy. 18-20 September 2013.

Background and aims Screening, Brief Intervention and Referral to Treatment (SBIRT) programs have been implemented widely in medical settings, with little attention focused on how well providers adhere to evidence-based service delivery in everyday practice. The purposes of this paper were to: (1) introduce a flexible, relatively simple methodology, the SBIRT Checklist for Observation in Real-time (SCORe), to assess adherence to evidence-based practice and provide preliminary evidence supporting its criterion validity; and (2) illustrate the feasibility and potential utility of the SCORe by analyzing observations of providers within four large-scale SBIRT programs in the United States. Methods Eighteen potential adherence judges were trained to recognize SBIRT service elements presented in realistic taped portrayals constructed to serve as criterion coding standards. Across the four SBIRT programs, 76 providers were observed performing 388 services in three types of medical settings; emergency departments (n = 10), hospital out-patient/ambulatory clinics (n = 16) and hospital in-patient settings (n = 5). Results Across two exercises, trainees identified 81% of screening and 75% of brief intervention (BI) elements correctly; for the six FRAMES components (Feedback, Responsibility, Advice, Menu of options, Empathy, Self-efficacy), agreement ranged from 69% to 91%. Across programs, 56% of screening, 54% of brief intervention (BI) (81% of FRAMES) and 53% of referral to treatment elements were observed. Programs differed significantly in adherence [screening, P = 0.024; BI, P

The rate of substance use disorders (SUD) within the U.S. is alarmingly high. According to the National Institute on Drug Abuse (NIDA), an estimated 23.9 million Americans ages 12 or older use an illicit drug or misuse a psychotherapeutic medication each month. 1 Patients presenting for anesthesia care are not exempt, and neither are our colleagues. While education and training about SUDs does happen in health professional programs at both the undergraduate and graduate levels, it is often difficult to describe practical solutions to this issue. The Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Interprofessional Groups of Anesthesia Students (InGAS) Project seeks to rectify this situation through didactic and simulation-based interprofessional education. Participants report gaining skills in substance use screening and are more comfortable using SBIRT techniques. Future efforts will be focused on refining the training process by expanding the scope of the simulation scenarios and thus, the opportunity for effective interventions.

This article offers a brief review geared toward primary care providers of the most critical aspects of the management of opiate use disorder, including screening, brief intervention, and referral to treatment as well as medication-assisted treatment and the alarming trends and dangers of illicitly produced fentanyl.

SBIRT (screening, brief intervention, and referral to treatment) is a comprehensive and integrated public health approach that aims to address hazardous and harmful substance use in patients through universal screening for substance misuse risk and the subsequent delivery of appropriate evidence-based interventions to reduce this risk. SBIRT has been implemented throughout all 50 states in a wide variety of medical settings. Thus far, over one million people across the country have been screened for substance use using SBIRT practices. SBIRT has also been implemented internationally. SBIRT is predicated on the premise that, like other chronic diseases, substance use falls along a clinical spectrum ranging from low to high risk. Patient substance use can be stratified across increasing risk levels that correlate with an appropriate disease state extending from abstinence to a diagnosable substance use disorder. Implications for treatment and prevention programs are discussed.

Research suggests that low-income adults accessing employment services have experienced high levels of trauma exposure and associated consequences. Moreover, the health-related effects of trauma undermine employment and employability. A trauma-informed protocol-trauma screening, brief intervention, and referral to treatment or T-SBIRT-was therefore implemented within employment service programs serving low-income urban residents. To assess the feasibility of integrating T-SBIRT within employment services, five domains were explored as follows: suitability, acceptability, client adherence, provider adherence or fidelity, and intended outcomes. With a sample of low-income adults (N = 83), the study revealed that T-SBIRT is suitable for employment service participants given high rates of trauma exposure (90.4% experienced two or more lifetime traumas), along with high rates of positive screening results for post-traumatic stress disorder (48.8%), major depression (35.4%), and generalized anxiety (47.6%). Study participants appeared to find T-SBIRT acceptable as evidenced by an 83% acceptance rate. All participants accepting T-SBIRT services completed them, revealing strong client adherence. Provider adherence or model fidelity was high, that is, 98.5%. Finally, the majority of participants accepted a referral to a mental health care (i.e., 56.6%), and over three-quarters accepted a referral to any outside service including primary or mental health care. Implications of findings are discussed.

Background Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based process to recognize and intervene with people who use substances. Despite evidence to support the SBIRT effectiveness, this process is rarely used in acute care. To facilitate use of SBIRT in acute care, it is important to first understand the implementation processes. Purpose To describe SBIRT processes across 14 acute care facilities. Methods A phone interview was conducted with site coordinators at 14 facilities to describe their SBIRT process and clinicians involved in each step. Findings Seven different SBIRT processes were identified for people that use alcohol and/or drugs, and five different processes were identified for people that use tobacco. The function of SBIRT was consistent throughout facilities, but the form of implementation varied based on organizational context. Discussion Future SBIRT dissemination efforts will need to first understand the local processes and clinicians involved within each facility to tailor implementation to local context.

Introduction: Referrals to sleep centres have increased in the UK. The waiting time to be seen far exceeds the stipulated 18 week Referral to Treatment (RTT). In our centre, patients referred for suspected OSA have a pre-clinic pulse oximetry. Those with a high Epworth Sleepiness score (ESS) are referred for LPS. WP a wrist mounted device measures arterial tone at the fingertip. Studies have validated the algorithm results by comparison with full PSG obviating the need for manual scoring. We conducted a pilot study comparing WP with LPS to assess patient preference, reliability of measured parameters and effect on RTT. Methods: Patients who did not have a diagnosis after pre-clinic pulse oximetry review were tested simultaneously with home LPS and WP. LPS tests were manually scored and compared with the automated report from the WP software. Results: 11 patients participated in the pilot study. Mean age was 40, mean BMI 35 and mean ESS was 14. Mean AHI on LPS was 15 and WP 17. Mean ODI on LPS was 18 and WP 7. Mean RDI on WP was 25. (see Table1). All patients were started on CPAP. Discussion: While the co-relation between AHI was good, WP underestimated ODI. The RDI on WP was an advantage. Manual scoring of LPS can incur a delay of a week plus clinician time. Patients were comfortable with WP as compared to LPS. Although this was a small pilot study, in view of the ease of use, shortening of the patient pathway time, good correlation of AHI, our centre is planning on using the WP device in regular practice.

This case describes Ben, a 14-year-old male who is presenting to his primary care physician for routine care. His parents report that they are concerned that he may be using marijuana and note that his grades and relationship with them have both declined. The case demonstrates use of the CRAFFT screening tool to assess Ben’s risk of a substance use disorder and provide a brief intervention and, if appropriate, referral to treatment.

OBJECTIVES: The Alcohol Use Disorders Identification Test (AUDIT) is used to assess the level of alcohol use/misuse and to inform the intensity of intervention delivered within Screening, Brief Intervention, and Referral to Treatment (SBIRT) programs. Policy initiatives are recommending delivery of SBIRT within healthcare settings to reduce alcohol misuse and prevent alcohol impaired driving. Recent reports are considering extending delivery of SBIRT to criminal justice settings. One consideration in implementing SBIRT delivery is the question of resource utilization; the amount of effort required in delivering the four different intensities of intervention in SBIRT: Alcohol Education, Simple Advice, Brief Counseling and Continued Monitoring, and Brief Counseling and Referral to Specialist (from least to most intense in terms of delivery time, the skill level of provider, and personnel resources). METHODS: In order to inform expectations about intervention intensity, this manuscript describes the AUDIT scores from 982 adults recently arrested for alcohol impaired driving. The distribution of scores is extrapolated to state rates for individuals arrested for alcohol impaired driving by intervention level. RESULTS: While Alcohol Education was the most common intervention category, about one-quarter of the sample scored in a range corresponding with the more intensive interventions using the Brief Counseling, Continued Monitoring for ongoing alcohol use, and/or Referral to Specialist for diagnostic evaluation and treatment. CONCLUSIONS: This manuscript provides local distribution of AUDIT scores and state estimates for the number of individuals scoring in each level of risk (AUDIT Risk Zone) and corresponding intervention type. Routine criminal justice practice is well positioned to deliver alcohol screening, education, simple advice, and continued alcohol monitoring, making delivery of SBIRT feasible for the majority of alcohol impaired drivers. Challenges to implementing the full range of SBIRT services are: resource demands of brief counseling, identifying the appropriate providers within criminal justice context, and availability of community providers for referral to diagnostic and specialty care. Solutions may vary by state due to differences in population density and incidence rates of alcohol impaired driving.

Objectives Due to improvements in earlier detection and expansions in available treatments, the number of individuals surviving with cancer is steadily increasing. Sexual dysfunction is a common and often persistent complication for cancer survivors, affecting >60% of women diagnosed with cancer. Although highly prevalent, issues related to sexual health are often not addressed among survivors, with women reporting less discussion with providers compared to men. Methods In this narrative review, we present a case series of three women seen in a psycho-oncology clinic who experienced sexual dysfunction following a cancer diagnosis. We then review existing literature on the presentation and management of sexual issues associated with cancer and its treatment. Results The three cases highlight different mechanisms of sexual dysfunction after cancer, including anatomic changes, hormonal alterations, psychiatric conditions and medication side effects. The literature review includes discussion of the prevalence and course of sexual dysfunction in female cancer survivors. Tools for screening and assessment are then reviewed, as well as contributing factors and common presenting symptoms. We conclude with a discussion of both pharmacologic and non-pharmacologic approaches to management. Conclusions Despite its high prevalence and considerable impact on quality of life, the complication of sexual dysfunction after cancer diagnosis and treatment is still under recognized and undertreated. Improving awareness, communication, and screening, as well as appropriate referral to treatment, could have a profound impact on the ever growing number of women surviving with cancer with sexual health concerns.