State Partners with United Neighborhood Health Services on Innovative Screening, Intervention, Referral Program

NASHVILLE – The Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS) has partnered with the United Neighborhood Health Services (UNH) in Madison, Tenn., to implement Tennessee’s Screening, Brief Intervention and Referral to Treatment Program (SBIRT) as part of its continuum of care and behavioral health program.

UNH serves the wellness and medical needs of a large, demographically diverse population in Davidson County. Dependent upon clinic flow, UNH will screen approximately 1,000 patients per month. They have joined three other active SBIRT primary-care providers in Tennessee: The Clinics at East Tennessee State University in Bristol and Johnson City, The Clinic at Nashville General Hospital, and Centerstone serving the Tennessee National Guard in Smyrna.

SBIRT is a comprehensive, integrated, public-health approach to the delivery of early intervention and treatment services for people with substance use disorders. A vital focus of the program is to offer opportunities for early intervention and treatment before severe consequences occur. At-risk individuals are defined as people who consume alcohol or other substances in ways that could lead to dependence and/or interfere with healthy lifestyles, and individuals in environments that expose them to or facilitate the potential for substance use and misuse.

Key components for accessing different communities and offering this program are primary care centers, hospital emergency rooms, trauma centers and other community settings including military environments. Primary care physicians, practitioners, licensed clinicians, and residents are trained under the SBIRT program to administer screenings and offer interventions or treatments. More intensive alcohol and substance abuse conditions are referred for treatment. The fundamental processes of SBIRT are:

• Screening: A single prescreen question that is universal and simple in approach as part of the standard medical intake process. For alcohol, the question for men is, “How many times in the past year have you had five or more drinks in one day?”  and the question for women is, “How many times in the past year have you had four or more drinks in one day?”  For drug use, the question is, “How many times in the past 12 months have you used a recreational drug or a prescription medication other than how it was prescribed?”
• Brief Intervention: Time-limited, structured, proven research procedures for working with individuals with at-risk use and abuse behaviors.
• Brief Treatment: Up to twelve (12) sessions; these include the monitoring of individuals who misuse alcohol and other drugs but are not yet dependent.
• Referral to Treatment: A process that facilitates access to care for patients who screen at high-risk for substance use problems. These patients are linked to substance abuse or mental health treatment agencies for formal diagnosis and possible treatment.

Integrating SBIRT into the standard of care at United Neighborhood Health Services, as well as at each of the partner sites, is helping to frame behavioral health services into whole health services around Tennessee and to reduce barriers to quality care that patients face every day. So far, the communities are responding: The impact and results of the screenings and services offered are proving that the SBIRT concept is highly beneficial.

The best course of action in the fight against substance abuse, and the goal of the SBIRT program, is to identify and treat it before it develops into a chronic disease.