Central East ATTC: Implementing Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Title X Family Planning Settings

January 15, 2019

Shelly Miller
Consultant, Central East ATTC
Subject Matter Expert, Family Planning

Over the past year, the Central East ATTC collaborated with the Region III, Title X Family Planning Program to integrate the SBIRT model for early intervention and treatment services for substance use disorder within reproductive health care centers. The goal is to build capacity for the Title X provider network to implement substance use screening tools, provide targeted counseling, and when appropriate, refer patients to treatment.

Project Activity

To pilot this project, the Central East ATTC identified five family planning health centers within the region. These sites represented urban and rural locations, Federal Qualified Healthcare Centers (FQHCs), hospitals, and community-based organizations.

Using a hybrid model of training and technical assistance (T/TA), Central East ATTC worked with the cohort collectively and with each site individually. Through virtual web-based meetings that allowed for face-to-face interaction, the cohort met monthly to address focused topics of interest. Central East ATTC facilitated and provided TA on how to implement the model using a 3-phrase process:

1. Orientation and Planning

2. TA on Implementation

3. Evaluation and Conclusion

Subject matter experts presented on numerous topics, including SBIRT Overview, SBIRT billing and coding, Motivational Interviewing, a “Model Clinic,” process mapping, prevalence of SUDs in family planning clinics, and data collection and evaluation. Central East ATTC hosted trainings on SBIRT and motivational conversations at each site, which were open to all staff and community partners.

Understanding that each site is unique, site meetings focused on each agency’s needs to develop its own own implementation plan, which will serve as a roadmap to direct T/TA needs and later to define the agency’s SBIRT policy and procedures. It was essential that throughout this project, Central East ATTC was sensitive to implementing SBIRT in a way that minimized staff time and clinic disruption.

Implementation plans focused on:

  • Agency Summary: size, staffing, clients served, community resources
  • Elements Facilitating Implementation Process: current efforts, leadership involvement/support, identified champions
  • Potential Implementation Obstacles: commitment of leadership and staff, community resources, infrastructure
  • Overarching Program Structure: current flow and staffing patterns/structure/roles, screening tools
  • Internal/External Behavioral Health Resources for Referral
  • Evaluation: what data can be collected and what is it measuring
  • Billing and Program Funding Support: management information systems integration

Findings, Lessons Learned, and Next Steps

Initial findings:

  • Feedback from cohort participants was consistently positive and included testimonials of immediate impact on identifying clients needing SUD services and successful referral to treatment. 
  • The Central East ATTC was able to link two of the sites to additional T/TA support in their local communities.
  • During this project, Central East ATTC worked with two FQHC sites, both of which look to expand the project from the individual site to their entire network. The Central East ATTC will continue to provide TA in these efforts.

Lessons learned:

As a pilot project, it was essential that there be thoughtful introspection on what worked well and what needed to improve. Evaluation used the PDSA (Plan, Do, Study, Act) model and identified the following issues:
  • Sites were not consistent in attending all collective meetings (future cohorts need more individualized meetings and fewer community meetings).
  • More concrete support and direction is needed from the onset in building implementation plans.

Next Steps:

  • The Central East ATTC is in the process of recruiting applicants for the next project cohort. 
  • During the first month, there will be a full day on-site launch meeting with identified lead staff from each agency.
  • The Central East ATTC will work with all participants to create a learning collaborative that supports and enhances current and on-going activity.

About Shelly Miller 

Shelley Miller has worked in family planning and reproductive health for more than 35 years, beginning her career as a counselor in women’s health. She has since served in a variety of roles including the Director of Patient Services for a large Title X agency and as the Director of Training Performance Improvement for TRAINING 3, a regional training center. Shelley has provided consultation, coaching, training and technical assistance, both nationally and internationally. Currently she is an independent consultant and for the past year has been working with the Central East ATTC in its SBIRT implementation project with Title X.

Contact information: Shellmill@gmail.com| 215-872-2324

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