The "Add Participant" button is enabled only if the "All" options is use to search for the patient's name. The picture below shows how the search options should be set to enable the button.

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There are at least three ways that you can put a copy of a patient's Personal Feedback Report (PFR) into your Electronic Medical Record (EMR). Which of these that you will use will depend on your EMR.

All of these methods start the same way:

1. Open the patient's eSBIRT record and go to their PFR.
2. At the top of the record is an Export link. Next to if is a drop down menu of options.

There are a variety of export options from which to choose.

Any of these will generate a file on your computer that can then be uploaded into your EMR.

Method 1 - Add a PDF copy

1. Select PDF from the menu and click the export link.
2. A PDF file will be saved on your computer. Rename it as you wish and upload it to the patient's EMR record.

Advantages: High fidelity copy that can be printed for later use.
Disadvantages: Not easily searchable. Multistep process. Care must be taken to not leave PHI on your personal computer.

Method 2 - Add an RTF copy

1. Select Rich Text Format from the menu and click the export link.
2. A rich text document file will be saved on your computer. Word opens these by default. Rename it as you wish and upload it to the patient's EMR record.

Advantages: High fidelity copy that can be printed for later use. As a word document it may be more easily searchable
Disadvantages: Searchability will be determined by the specific EMR. Multistep process. Care must be taken to not leave PHI on your personal computer.

Method 3 - Paste into a text entry box (when you don't want to upload a file)

1. On the web site select the text in the PFR and copy it.
2. In the EMR go to the text box where you would like this information (e.g., a clinical note) and paste the text. (Note that sometimes the graphs do not get pasted in the correct location. It that is a problem, export the Rich Text Format into Word, select and copy the text in that document and paste it into the text box.)

Advantages: One step cut-and-paste process. No PHI stored on your computer. Searchable to the extent that the EMR searches notes.
Disadvantages: Graphics may be misplaced. Will not print a high fidelity version from the EMR note.

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For these screens and assessments to be used with adults who are developmentally delayed they would need to be verbal and living either independently or some place with a lot of freedom to be at risk. That would eliminate individuals who are very low functioning and nonverbal.

However, folks with developmental delays do engage in risky substance use and if they are positive on the prescreen it would be appropriate to use eSBIRT to help you determine and deliver an appropriate level of service adapting it to the capabilities of the individual.

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The federal confidentiality rules in 42 CFR Part 2 would not apply to primary care health homes in most cases because they do not normally meet the definition of a “program” (i.e., substance abuse treatment is not their principal practice) and do not hold themselves out as providers of alcohol and drug abuse treatment services:

Further, while the term “general medical care facility” is not defined in the definitions section of 42 CFR 2.11, hospitals, trauma centers, or federally qualified health centers would generally be considered “general medical care” facilities. Therefore, primary care providers who work in such facilities would only meet Part 2’s definition of a program if 1) they work in an identified unit within such general medical care facility that holds itself out as providing, and provides, alcohol or drug abuse diagnosis, treatment or referral for treatment, or 2) the primary function of the provider is alcohol or drug abuse diagnosis, treatment or referral for treatment and they are identified as providers of such services.  [Source:  http://www.samhsa.gov/about/laws/SAMHSA_42CFRPART2FAQII_Revised.pdf.]

Of course, the lines in some cases are not clear, and any agency in question should seek legal counsel.

MARK STRINGER
Director
Division of Comprehensive Psychiatric Services
Division of Alcohol & Drug Abuse
Department of Mental Health
1706 E. Elm St.
Jefferson City, MO  65101
Phone (573) 751-9499
Fax (573) 751-7814
Mark.Stringer@dmh.mo.gov  

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Connection to internet (wired or wireless)

Must have Javascript enabled

Tested browsers

• Chrome
• Firefox
• IE (versions 8 and 9)

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I am trying to enter in second reports for individuals whose original report is over one year old. I have tried everything I can think of short of deleting their old record and reentering the new. I am hoping there is another way to do this. Could you please advise me on how to proceed

Generally the cause of this is that the previous screening was not completed and the person was never discharged. To enter a new screening record search for the patient and discharge them. At that point a new screening can be entered.

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Absolutely. Anyone with authorization to your patients' on eSBIRT can complete the process. Permalink

The eSbirt site offers three levels of training:

• Screening
• Brief Education/Intervention (5-15 minute intervention)
• Brief Coaching (up to 5 sessions)

A description of the training and costs is available.A training preview is available to unregistered users by clicking the SBIRT Training Preview menu.

To begin training for credit register on this site. You will receive an email with a verification link. Clicking that link will send you back to the site to login verifying your email address. Once verified, select the SBIRT Training menu option to start training.

NOTE: This training is open to all registered users. You do not need to be a Missouri Primary Care Health Home provider to take the training or receive certifications.

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If you see a pink or other color border around eSBIRT.org while using Internet Explorer you will need to view the site in the compatibility mode. 

Turning ON the compatibility view

Click on the unhighlighted compatibility view button in the IE address bar

Turning OFF the compatibility view

Click on the highlighted compatibility view button in the IE address bar

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eSBIRT uses screens that have been validated on adults (18+ years old). Because of this it does not accept screens on individuals younger than 18.

To screen youth we recommend the CRAFFT.

The CRAFFT is a behavioral health screening tool for use with children under the age of 21 and is recommended by the American Academy of Pediatrics' Committee on Substance Abuse for use with adolescents. It consists of a series of 6 questions developed to screen adolescents for high risk alcohol and other drug use disorders simultaneously. It is a short, effective screening tool meant to assess whether a longer conversation about the context of use, frequency, and other risks and consequences of alcohol and other drug use is warranted. CRAFFT Website

The assessment is available for multiple languages in two formats:

• Self-administered.
• Clinician administered.

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1. In the past 3 months, how often do you have a drink containing alcohol?
2. In the past 3 months, how many drinks containing alcohol do you have on a typical day when you are drinking?
3. Females (and Males over 65): In the past 3 months, how often do you have 4 or more drinks on one occasion?
   Males: In the past 3 months, how often do you have 5 or more drinks on one occasion?
4. In the last twelve months, did you smoke pot, use another street drug, or use a prescription painkiller, stimulant, or sedative for a non-medical reason?

Prescreen provider completed version (pdf) Permalink

As in all medical procedures it is a patient's right to refuse. However, it is often the case that refusals are based on misunderstandings. So, ask the patient why they do not want to participate. Based on their concerns some possible responses include:

• “Your doctor feels that your health habits are important to your overall health.“
• “We ask the questions of everyone and we don’t single anyone out.”
• “We have a set of standard questions that we ask everyone to make sure we provide the best care possible.”
• “We ask everyone to help improve our patients’ long-term health.”
• “We ask everyone, as substance misuse is a major factor in accidents, injuries and chronic health conditions.”

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eSBIRT is a secure web based system built to collect the information and support service provision for Screening Brief Intervention and Referral to Treatment (SBIRT) programs. eSBIRT supports unlimited users, programs, sites, and locations.

eSBIRT walks users step-by-step through the SBIRT assessment and service process.(Demographics > Prescreen > Full Screen > Drinking comparison > Readiness to change > Personal feedback report > …

As users respond to questions, it dynamically tailors its self so that no unnecessary information or assessments are ever presented. Questions and information are provided a page at a time making it easier for users to contextualize the content and respond. Data quality checking is built into the system highlighting issues for the user before the data is saved. This user experience has been used successfully by both trained SBIRT staff and untrained users. All assessments are available in English or Spanish.

At the conclusion of the assessment process eSBIRT enumerates the individual’s risks and recommends a service that is specific to their needs.

Services for most individuals are based upon motivational interviewing techniques. Because of this, a Personal Feedback Report is generated for each individual to support motivational enhancement. This report describes the various risks the individual faces, compares their current behaviors with normative data, and offers specific behavioral change recommendations based on their current readiness to change. In addition to its use during motivational interviewing, the report is printed, allowing individuals to take it home for further reflection.

eSBIRT provides evidence base manualized service guidance for a single brief (about 15 minutes) session and for those needing the next step up in services, five one hour sessions. For each type of session, providers are briefly reminded of the topics to cover and the approach to be taken. Each session includes an explicit evaluation by the staff and patient to help measure their impact. For individuals needing referral eSBIRT tracks warm hand off activities.

In sum, eSBIRT provides a usable, secure, and flexible platform for the provision and reporting of SBIRT services.

Download a PDF of this description.

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The local ID number is whatever number you use to uniquely identify this patient in your EMR. It may be called a case number or patient ID. What is important is that this number is used to identify the patient each time they are admitted/seen by your site. Permalink

• Conduct SBIRT screening with ALL patients 18 and older
• Screening is designed to be completed once per year.
• Seven questions (5 SBIRT and 2 Depression questions)
• PHQ 2 Depression Screening will be added to SBIRT screener to allow ease in administering required yearly depression screening
• CHC will need to create or adapt screens and/or templates in EMR according to MPCA recommendations to capture SBIRT pre-screen answers for reporting to FQHC, MOSBIRT, and MO HealthNet Division for the MO Primary Care Health Home Initiative (costs associated with creating/adapting screens or templates in the EMR will be the responsibility of the CHC).
• MPCA is working with Arcadia and MIMH regarding the IT for the implementation of SBIRT and mapping/reporting to the data warehouse (mapping costs to the data warehouse will be covered by MPCA contract with MIMH)

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• Staff member rooming the patient asks the patient the SBIRT prescreen questions once per year
• Answers are entered directly in the EMR (distinct data fields)
• Positive screening results on the SBIRT questions require additional action.
• Positive SBIRT requires the administration of the ASSIST assessment developed by the World Health Organization and ideally is performed by the behavioral health consultant to determine if further action is needed. This is done in the eSBIRT system.

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