Embracing Change: The Fluidity of Evidence-Based SBIRT

 By Diana Padilla, CLC, CARC, CASAC-T, on behalf of Northeast & Caribbean ATTC 

The SBIRT Framework 

Screening, Brief Intervention and Referral to Treatment, also referred to as SBIRT, is an evidence-based practice designed to intervene with people who are at risk of health and psychosocial consequences stemming from their risky levels of alcohol consumption and/or other substance use.

As a comprehensive, integrated, public health approach, the components of the SBIRT model include screening for substance use, and when warranted, a brief intervention (dialogue using Motivational Interviewing core communication skills) and referral to treatment. An array of non-substance use disorder treatment settings provide opportunities to identify and reduce harmful levels of consumption with people who generally don’t meet the criteria of a substance use disorder but are experiencing adverse effects as a result.  

Adapting SBIRT

The NeC-ATTC has provided technical assistance and implementation support to organizations seeking to integrate SBIRT in HIV programs, prevention and recovery support organizations, state agencies, and community peer-based initiatives. As such, SBIRT has been adapted to meet specific community needs. 

Based on the focus of programs and target populations, we have helped providers learn to use SBIRT to screen and address problematic behavior related to specific health issues. Creating an atmosphere that is physically and cognitively conducive to helping people feel comfortable and likely to engage is key. Validated screening tools specific to the identified health concern are used as required within the context of the SBIRT model.

A brief intervention dialogue using motivational interviewing core communication skills allows for a person-centered interaction that can help clients consider options for addressing behavior that may impede them from meeting their identified goals. A brief intervention that is effectively delivered helps to build receptivity to a referral for further assessment and possible treatment.  We have found that the components of the SBIRT intervention can be adapted to fit a variety of specific health issues beyond just problematic substance use without compromising the fidelity of the evidence-based practice.  

Expanded Application of SBIRT: Case Study

While major depression and general anxiety disorders are the most diagnosed mental health disorders in the US, they are severely underdiagnosed among the Black community. 

Although socio-economic, cultural, and contextual factors contribute to health disparities for people of color, stigmatizing beliefs about mental illness lend to the underdiagnosing of these disorders for African American populations. As such, the SBIRT model has the potential to enhance the identification of mental health issues within diverse communities.  

Currently, the NeC-ATTC is providing technical assistance support to Dr. Sidney Hankerson, Columbia University’s pilot study, “Depression Screening in Black Churches,” a clinical trial testing the viability of using SBIRT with African Americans versus the traditional mental health referral process. 

The study recognizes that African Americans have the highest rates of church attendance among all racial/ethnic groups in the U.S., with over 60% attending church several times per month. Approximately 72% of African Americans with serious personal problems, including depression, seek help in Black churches.

The pilot program recruits members of church congregations, (30 churches involved in the study) to train as Community Health Workers (CHWs) in the facilitation of SBIRT. It is hypothesized that using SBIRT may bridge the gap between depression screening and access to treatment. Part of the cultural framework for initiating SBIRT includes CHWs representative of the diverse communities who also attend the churches where the study is piloted. This offers both the faith-based and racial-cultural affiliations that can help increase the likelihood that community members will participate in the study, get screened, and possibly link to mental health care.  

Cultural Benefits of SBIRT Adaptation 

With health care disparities reported as extremely high amongst diverse populations, the flexibility of SBIRT model provides opportunities to reach diverse populations who struggle with conditions that may not necessarily be identified and treated in traditional health care processes.  

The Depression Screening in Black Churches is an ongoing study. But the hope is that data will show that SBIRT can help increase access to care for African American communities burdened with a high prevalence of depression and possibly other mental illnesses.  If so, it can open the door for more studies as well as training for clinicians and providers to help meet the needs of culturally diverse individuals and advance equity in care.

Depression Screening in Black Churches

https://clinicaltrials.gov/ct2/show/NCT04524767

Sponsor:

Columbia University

Collaborator:

National Institute of Mental Health (NIMH)

Information provided by (Responsible Party):

Sidney Hankerson, Columbia University

Author bio: Diana Padilla, is a Research Project Manager, at the New York State Psychiatric Institute, Division of Substance Use Disorders, Columbia University Medical Center. She is a curriculum developer and senior trainer for the Northeast & Caribbean Addiction and Prevention Technology Transfer Centers. She is certified by the New York State Office of Addiction Services and Supports (NYS OASAS) as an SBIRT trainer.