In 2011, the Substance Abuse and Mental Health Services Administration (SAMHSA) awarded the state of Indiana a five-year grant to implement Screening, Brief Intervention, and Referral to Treatment (SBIRT) services into Community Health Centers (CHCs), Federally Qualified Health Centers (FQHCs), and Rural Health Centers (RHCs) across Indiana. This grant was awarded in 2011 and will continue through 2016 (2012 SFY-2017 SFY).
Since 2011, the Indiana Prevention Resource Center (IPRC) and the Division of Mental Health and Addiction (DMHA) have been working to foster the adoption of SBIRT services into the standard of primary care throughout the state, with the ultimate goal being to reduce drug and alcohol consumption and related negative health outcomes for Hoosiers.
Indiana SBIRT has six key goals:
1. Develop an effective means of integrating SBIRT into clinical practice that can be adopted by all CHCs, FQHCs, and RHCs in Indiana.
The Indiana SBIRT team has developed a “clinical process flow” that can easily be integrated into an organization’s current patient flow.
2. Establish an infrastructure for training clinical staff to perform SBIRT services at clinics.
A variety of trainings have also been developed to ensure that all staff members involved in the SBIRT process received adequate training. The Indiana SBIRT team and staff at the IPRC developed an online training portal. Available trainings include SBIRT and motivational interviewing trainings/webinars, and various drug modules. The training portal also can be used to reserve in-person trainings in SBIRT and motivational interviewing.
3. Collect screening data to evaluate the impact of SBIRT.
In order to monitor the efficacy of SBIRT, the following data is collected:
4. Perform cost-analyses to identify the fiscal benefits of SBIRT.
Indiana SBIRT completes quarterly reports to DMHA, which helps to determine how costs may be offset and how to make the SBIRT process to be more sustainable.
5. Disseminate the SBIRT model throughout the state of Indiana.
In the first two years, SBIRT was implemented within 10 CHCs (Eskenazi Health). These sites were awarded funding to hire new staff members dedicated to delivering SBIRT. Indiana SBIRT then worked to expand these services to expansion sites across the state. Over the course of three years 11 expansion sites (CHCs, RHCs, and FQHCs) received seed-funding to adopt SBIRT into their standard of primary care. These 11 health care organizations received Cooperative Community Expansion to Primary Care seed-funding. This grant is designed to be used by existing staff at CHCs, RHCs, and FQHCs to reduce barriers (such as funding, training, support, assistance etc.) to adopting SBIRT. There are currently 22 centers across Indiana offering SBIRT services as a standard of primary care. Click here to view the interactive map or to learn more about the 22 Indiana SBIRT sites.
6. Sustain SBIRT services in clinics beyond the life of the SAMHSA-funded initiative.
The Indiana SBIRT team is working to create sustainability in SBIRT services. Over the past 3 years, Indiana SBIRT has incorporated an embedded clinician method, which allows an organization to use existing staff and implement SBIRT. This method is more sustainable, as new employees are not hired and funded through the grant. Furthermore, this method of implementation is more realistic, as these sites are funded to modify services in real time.
SBIRT has also worked to develop alternative billing codes; now mid-level providers are able to bill for SBIRT services. Using appropriate billing codes to be reimbursed for SBIRT services enhances sustainability, especially after the grant ends.
The Indiana SBIRT team has partnered with the integrated care movement.
The team has also been working on the development of an organizational readiness assessment, the development of a patient flow document, providing fidelity instruments and appropriate billing codes and designing free online training modules.
