The Elevator Pitch
MOSBIRT is a substance abuse prevention project that will screen up to 200,000 Missourians in various medical settings for risky substance use behaviors. Those at risk are offered 1 to 6 brief evidence based sessions to reduce those risks. With this early intervention, individual trajectories can be altered preventing future substance abuse and dependence.
MOSBIRT is funded by a five year $12.3 million grant from the Substance Abuse and Mental Health Services Administration. Written by the Missouri Institute of Mental Health in collaboration with the Missouri Department of Mental Health, the grant supports the development and testing of a computer supported evidence based system and its use by trained health coaches in emergency departments and family medicine clinics in Springfield, Columbia, and St. Louis Missouri.
MOSBIRT is a Screening, Brief Intervention, and Referral to Treatment (SBIRT) program. In it individuals seeking medical care are screened for risky substance use behaviors. On average, 80% of those screened will have no significant risks, 12% will receive a single brief education session, and 3% will receive six health coaching sessions, and 5% will need referral for substance abuse services.
There is an emerging body of research and clinical experience that supports the use of SBIRT as a set of effective interventions for persons at risk. These programs have been shown to significantly reduce ongoing medical costs, reduce the use of alcohol and drugs, and increase levels of abstinence.
Grant Application Abstract
Little attention has been paid to the large group of individuals who misuse prescription and illicit drugs, alcohol, and tobacco but could successfully reduce their physical, behavioral, and addictive risks through early intervention. There is an emerging body of research and clinical experience that supports the use of screening, brief intervention, referral, and treatment (SBIRT) as a set of effective interventions for persons at risk.
Missouri’s SBIRT project will build upon the work of previous grantees incorporating manualized evidence based practices into a tablet computer. Using this system, trained substance abuse professionals will conduct face-to-face screening of all individuals entering selected medical care facilities for signs of the misuse of prescription and illicit drugs, alcohol, and tobacco. Most screened patients will have no problems. Of those who do show troubling behaviors, our staff will provide evidence based direct services, either a one session brief intervention or 6 session brief treatment, at the medical facility. For those who already show abuse or dependence we will employ an evidence-based warm hand-off process to get them into a specialized substance abuse treatment program.
Our SBIRT implementation will begin at a family practice clinic and ER in Springfield Missouri and an ER in Columbia, Missouri. These practices provide general medical care or emergency treatment to over 50,000 individuals each year.
Over the five years of the project, the moneys provided will develop and demonstrate effective SBIRT processes in general and emergency medical settings. The project will screen over 80,000 Missourians, serving approximately 25,000 individuals’ with significant risk behaviors before they become addicted (indicated prevention) and make treatment referrals for more than 1,500.
Missouri’s ADA Division will seek collaborative partners at the State and local levels to add this new service to the continuum of care. To sustain and expand these successful demonstrations, Missouri’s Department of Mental Health will work with the Department of Social Services to define screening service codes in Medicaid to enable reimbursement. The Department will also work with the State legislature and other sources to fund additional SBIRT initiatives. Additionally, they will work with insurance companies to fund these services in emergency rooms.
With this project Missouri will fill a gap in our continuum of care, develop and showcase an effective SBIRT implementation, demonstrate the impact of that demonstration on the health of individuals and the costs to society, and create an environment in which a sustainable SBIRT can spread across the state.