Successful Implementation of an Alcohol Screening, Brief Intervention, and Referral to Treatment Program

Abstract

Devastating effects of alcohol are well established in trauma. To address this, thve American College of Surgeons Committee on Trauma (ACS-COT) requires ACS-verified Level 1 trauma centers to have an active screening, brief intervention, and referral to treatment (SBIRT) program. In 2015, NewYork-Presbyterian/Queens successfully implemented an SBIRT program. Previous studies indicate difficulty in achieving a high level of SBIRT compliance. We explored the effects of a multidisciplinary approach in implementing a standardized screening protocol for every trauma-activated patient 15 years or older. A multidisciplinary team developed a standardized approach to identifying trauma patients for our SBIRT program. Social workers were trained in performing brief interventions and referral to treatment at a New York State-level training course prior to starting our SBIRT program. Blood alcohol levels were obtained in every trauma activation. Trauma patients who had a blood alcohol level greater than 0.02% were identified and tracked by the trauma service. These patients were referred to social workers, underwent brief intervention, and evaluated for referral to treatment if determined to be a high-risk alcohol user. Over the 8-month implementation period, we evaluated 693 trauma patients. A blood alcohol level was obtained on most trauma patients (n = 601, 86.6%). Patients with a blood alcohol level greater than 0.02% were referred to a social worker (n = 157, 22.6%). Social workers performed a brief intervention and evaluation for referral/treatment services for 129 of the trauma patients with elevated blood alcohol levels. Overall, 82% of intoxicated trauma patients underwent brief intervention, which identified 22 patients who were referred for treatment programs. An inclusive multidisciplinary approach to the implementation of an SBIRT program achieves a high level of compliance.

Factors Impacting on Development and Implementation of Training Programs for Health Professionals to Deliver Brief Interventions, with a Focus on Programs Developed for Indigenous Clients: A Literature Review

“…This review also touches on the sustainability of the skills gained by health workers through BI training. To address this issue, the review has identified efforts such as: flexible ongoing training methods, in-person site visits, training materials designed specifically for the unit settings, monthly calls or in-person booster sessions to enhance ongoing implementation efforts [39]. For programs that are developed for Indigenous populations, the review affirms the importance of addressing specific client needs and consultation with Indigenous communities [33,37].…”

“…In the area of delivery of brief interventions by health professionals to their clients, the availability of resources (learning materials, assessment tools and referral guides) and how they were managed within the organisation, and the program's fit with the structural characteristics of the organisation were important [39]. BI delivery needs to be developed as a systems-based practice, with BI and referral to treatment services ideally being active processes.…”

Routine alcohol screening in the ED: unscreened patients have an increased risk for hazardous alcohol use

“…Given the reported overall small effect of brief interventions4 5 and the generally reported high number of missed patients when screening the entire ED population,7–9 it would be worth considering targeting the screening on patients presenting with factors associated with hazardous alcohol use. Studies performing SBIRT according to this approach reported a lower number of unscreened patients 20 21. Adopting narrower screening criteria may decrease costs and increase specificity, especially when the occurrence of hazardous alcohol use in the total ED patient population is low 6–8 22…”

Structural Cohesion, Role Equivalence, or Homophily: Which Process Best Explains Social Homogeneity?

“…The relationships assessed were recognition among professionals, information exchange, and user referral. Previous studies suggest that these relationships are especially relevant in the context of intervention programs implemented by interprofessional teams [ 65 , 66 ]. The relational data were transferred to binary adjacency matrices processed with UCINET software [ 33 ], which was used to calculate centrality measures, the core–periphery structure of the three types of networks in each region, and the level of homophily/heterophily of each actor using as a reference attribute the professional profile of the implementers (psychologists, social workers, and community promoters and support staff).…”