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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CHCs participating in the Missouri Primary Care Health Home Initiative will receive $30,000 in one time funding to cover the costs associated with start-up for the implementation of SBIRT
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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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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:
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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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To prevent unnecessary duplicate data entry, the PHQ2 is no longer entered in eSBIRT.
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DSS will not offset the funding on the cost report due to originating from a federal agency (Susan received e-mail confirmation from DSS)
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