Sustaining Screening, Brief Intervention and Referral to Treatment (SBIRT) services in health‐care settings

Abstract

Aims To assess the sustainability of Screening, Brief Intervention and Referral to Treatment (SBIRT) services after cessation of initial start-up funding. Design Descriptive study with quantitative and qualitative data collected from 34 staff participants from six grantees (comprising 103 sites) funded previously through a large, federally supported SBIRT program. Setting Primary care out-patient clinics and hospitals in the United States. Participants Thirty-four granteerelated staff members, including administrators, evaluators, key stakeholders and SBIRT service providers from six grantees. Measurements Changes to levels and types of service delivery activities after federal funding stopped, alternative sources of funding and obstacles to delivery of services. Findings Of the 103 original sites in the six SBIRT grantee programs, 69 sites continued providing services in some capacity (same as before, reduced, modified or expanded). Most of the 69 sites (67%) adapted and redesigned the delivery of SBIRT services post-initial grant funding. In addition, new sites were added after grant funding ended, bringing the total number of sites to 88. Analysis of participant responses identified four primary factors that influenced SBIRT sustainability: presence of champions, funding availability, systemic change and SBIRT practitioner characteristics. Conclusions Almost 70% of the Screening, Brief Intervention and Referral to Treatment (SBIRT) services in the United States funded initially through a federal program were able to sustain operations after federal funding ceased and some expanded SBIRT services beyond the original sites. The key factors related to sustainability were securing new funding, having champions, adapting and making system changes and managing program staffing challenges.

The Sustainability of Evidence-Based Interventions and Practices in Public Health and Health Care

“…Many studies have used a qualitative or mixed-methods approach to understand barriers and facilitators to sustainability (5, 10, 37). Consistent with organizational contexts in community settings (e.g., schools), many of these studies, particularly those in clinics or hospitals, suggest that funding, organizational factors and support (e.g., champions, supervision), and practitioner/workforce characteristics (e.g., turnover) are particularly influential (13,98,125 …”

“…Some research suggests that adaptation is likely necessary to promote sustainability (7,8,23), although other studies suggest that certain types of adaptation decrease the benefits associated with the intervention (68, 128). What is currently known, though, is that although high fidelity has been associated with positive program outcomes (34), adaptation is fairly common (3,86,125,150) and often necessary.…”

“…Some research suggests that adaptation is likely necessary to promote sustainability (7,8,23), although other studies suggest that certain types of adaptation decrease the benefits associated with the intervention (68, 128). What is currently known, though, is that although high fidelity has been associated with positive program outcomes (34), adaptation is fairly common (3,86,125,150) and often necessary.It is important to consider that some adaptations are not deviations from the original effective components of the program and may be beneficial (11,21,22,148). For example, there is evidence that family-based interventions to reduce substance use reach more minority participants if they are adapted to fit local culture and context (e.g., to reflect sociocultural values of Hispanic populations and rural settings) (59,69,82).…”

Screening, Brief Intervention and Referral to Treatment: implications of SAMHSA's SBIRT initiative for substance abuse policy and practice

“…Ideally, the programs could then sustain themselves through alternative sources of funding, or become integrated sufficiently with the established health-care system so that the SBIRT services continued uninterrupted. Under these circumstances, as Singh et al [32] note, research into the factors that facilitate or impede the SBIRT sustainability following the cessation of start-up funds becomes all the more important. Their study used qualitative data from interviews with key SBIRT program staff representing six of the seven SAMHSA cohort 1 programs.…”

Screening, Brief Intervention and Referral to Treatment (SBIRT): rationale, program overview and cross‐site evaluation

“…Two papers in this supplement address program sustainability issues and two explore issues related to the potential impact of the SAMHSA SBIRT grant program on broader treatment systems in the United States. The first sustainability paper [31] describes the sustainability achieved by the first cohort of SBIRT programs. The second sustainability paper explores financing issues associated with the delivery of SBIRT in the United States [32].…”