SBIRT : S creening, B rief I ntervention, R eferral to T reatment

SBIRT: Screening,Brief Intervention,

Referral to Treatment

Stephen Ferrante, M.S.W.Group Victory Managing Partner

Barry University School of Social Work Professor [email protected]

954-249-2323

September 27, 2013

SpecializedTreatment

PrimaryPrevention

BriefIntervention

None

Mild

Moderate Severe

Substance Abuse Severity and Level of CareAdapted from the SAMHSA TIP #34 (1999) and Institute of Medicine (1990)

Substance Abuse

Severity

SBIRT Core Components

SBIRT Approach National Evidence-based Initiative for Screening,

Brief Intervention, and Referral to Treatment

• Engagement

• Pre-Screening: Risk Identification

• Screening & Assessment: Risk Intensity

• Appropriate Intervention: Brief Intervention / Brief Treatment / Outpatient Treatment / Inpatient Care / Referral Ancillary Services

• Discharge with Outcome Screening

• Follow-up Screens

SBIRT Process • Universal Prescreening

– Symptoms Identification Difficult – Minimal Self-Referral

• Full Assessment for Positive Prescreen

• Level of Risk dictates Service Type:– Screening & Feedback (SF) for negative screens– Brief Intervention (BI) for moderate risk– Brief Treatment (BT) for moderate to high risk– Referral to Treatment (RT) - high risk/problem use

Prescreen: Part I

Prescreen: Part II

Alcohol, Smoking, Substance Involvement Screening Test (ASSIST)

World Health Organization (WHO)

• Interview Style Screen Administered for Positive Prescreen

• ASSIST developed to help healthcare professionals detect and manage substance use

• Scores provide a “level of risk” for substance misuse and type of service that follows:– Low risk = Screening & Feedback about results– Moderate risk = indicates the need for Brief Intervention – Moderate to High Risk = Brief Treatment – High Risk = Referral to Treatment

Motivational InterviewingTherapeutic Alliance

• People who “Screen Positive” for Substance Misuse – May be reluctant to seek help – May be ambivalent about decision to change behavior

• Confrontation & Labeling may Produce “Resistance” and/or “in Denial”

• Avoiding Labeling & Confrontation

• Roll with Resistance

• Enhance Self-Efficacy

• Build Confidence in One’s Coping Strategies

Motivational Interviewing

• Acknowledging Motivation, Readiness & Ability for Change

• Meeting Individuals Where They are

• Respectful Listening

• Accepting Individual’s Perspective

• Identifying Consequences of Problem

• Facilitating Perception Shift on Impact of Problem

• Empowering Individual to Generate Insights & Solutions

• Expressing Belief in Person’s Capacity to Change

• Offsetting Denial, Resentment & Shame

Early SBIRT Examples

• Emergency Departments– Bernstein E, Bernstein J, Levenson S: Project ASSERT: An

ED-based intervention to increase access to primary care, preventive services, and the substance abuse treatment system. Ann Emerg Med , 1997; 30:181-189.

• Primary Care Practices as “Brief Physician Advice” – Fleming, MF., Manwell, LB, Barry, KL, Adams, W, &

Stauffacher, EA Brief physician advice for alcohol problems in older adults: A randomized community-based trial. J Fam Pract; 1999 48(5): 378-84

SBIRT Today• Emergency Departments• Hospital Units• Primary Care Practices• Urgent Care• Federally Qualified Health Center • Health & Behavioral Health Clinic• Addiction Facilities • Educational Institutions • Community Service Settings

Health Care Providers can Provide SBIRT Services under Medicare

• Medicare pays for medically reasonable & necessary SBIRT services in physicians’ offices & outpatient hospitals

• Physicians, Physician Assistants, Nurse Practitioners, Clinical Nurse Specialists, Clinical Psychologists, or Clinical Social Workers can bill for SBIRT

• To bill Medicare, providers of MH services must be:– Licensed or certified to perform mental health services

by the state in which they perform the services;– Qualified to perform the specific mental health services

rendered; and– Working within their State Scope of Practice Act

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/SBIRT_Factsheet_ICN904084.pdf

SBIRT Billing & Reimbursement

• Affordable Care Act Recommended Service

• Screening & Brief Intervention Reimbursement – Commercial insurance CPT codes– Medicare G codes– Medicaid HCPCS codes

• Florida has not approved Medicaid Billing Codes

• SAMHSA Block & SBIRT Grants

Payer Code DescriptionFee

Schedule

CommercialInsurance CPT

99408

Alcohol and/or substance abuse structured screening and brief intervention services; 15 to 30 minutes

$33.41

CPT 99409

Alcohol and/or substance abuse structured screening and brief intervention services; greater than 30 minutes

$65.51

Medicare

G0396

Alcohol and/or substance abuse structured screening and brief intervention services; 15 to 30 minutes

$29.42

G0397

Alcohol and/or substance abuse structured screening and brief intervention services; greater than 30 minutes

$57.69

Medicaid H0049 Alcohol and/or drug screening $24.00

H0050Alcohol and/or drug service, brief intervention, per 15 minutes $48.00

SBIRT Coding http://sbirt.samhsa.gov/coding.htm

CPT Code Description

90801 Diagnostic interview

90804 Individual psychotherapy, 20‒30 minutes

90806 Individual psychotherapy, 45‒50 minutes

Common Behavioral Health Codes

http://sbirt.samhsa.gov/about.htm

The Result:A 16-session curriculum manual for conducting brief treatment

(Dupree & Schonfeld, CSAT, 2005)

http://kap.samhsa.gov/products/manuals/pdfs/substanceabuserelapse.pdf

Questions Answers

Comments

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