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SBIRT : S creening, B rief I ntervention, R eferral to T reatment. Stephen Ferrante, M.S.W. Group Victory Managing Partner Barry University School of Social Work Professor [email protected] 954-249-2323 September 27, 2013. Substance Abuse Severity and Level of Care - PowerPoint PPT Presentation
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SBIRT: Screening,Brief Intervention,
Referral to Treatment
Stephen Ferrante, M.S.W.Group Victory Managing Partner
Barry University School of Social Work Professor [email protected]
954-249-2323
September 27, 2013
SpecializedTreatment
PrimaryPrevention
BriefIntervention
None
Mild
Moderate Severe
Substance Abuse Severity and Level of CareAdapted from the SAMHSA TIP #34 (1999) and Institute of Medicine (1990)
Substance Abuse
Severity
SBIRT Core Components
SBIRT Approach National Evidence-based Initiative for Screening,
Brief Intervention, and Referral to Treatment
• Engagement
• Pre-Screening: Risk Identification
• Screening & Assessment: Risk Intensity
• Appropriate Intervention: Brief Intervention / Brief Treatment / Outpatient Treatment / Inpatient Care / Referral Ancillary Services
• Discharge with Outcome Screening
• Follow-up Screens
SBIRT Process • Universal Prescreening
– Symptoms Identification Difficult – Minimal Self-Referral
• Full Assessment for Positive Prescreen
• Level of Risk dictates Service Type:– Screening & Feedback (SF) for negative screens– Brief Intervention (BI) for moderate risk– Brief Treatment (BT) for moderate to high risk– Referral to Treatment (RT) - high risk/problem use
Prescreen: Part I
Prescreen: Part II
Alcohol, Smoking, Substance Involvement Screening Test (ASSIST)
World Health Organization (WHO)
• Interview Style Screen Administered for Positive Prescreen
• ASSIST developed to help healthcare professionals detect and manage substance use
• Scores provide a “level of risk” for substance misuse and type of service that follows:– Low risk = Screening & Feedback about results– Moderate risk = indicates the need for Brief Intervention – Moderate to High Risk = Brief Treatment – High Risk = Referral to Treatment
Motivational InterviewingTherapeutic Alliance
• People who “Screen Positive” for Substance Misuse – May be reluctant to seek help – May be ambivalent about decision to change behavior
• Confrontation & Labeling may Produce “Resistance” and/or “in Denial”
• Avoiding Labeling & Confrontation
• Roll with Resistance
• Enhance Self-Efficacy
• Build Confidence in One’s Coping Strategies
Motivational Interviewing
• Acknowledging Motivation, Readiness & Ability for Change
• Meeting Individuals Where They are
• Respectful Listening
• Accepting Individual’s Perspective
• Identifying Consequences of Problem
• Facilitating Perception Shift on Impact of Problem
• Empowering Individual to Generate Insights & Solutions
• Expressing Belief in Person’s Capacity to Change
• Offsetting Denial, Resentment & Shame
Early SBIRT Examples
• Emergency Departments– Bernstein E, Bernstein J, Levenson S: Project ASSERT: An
ED-based intervention to increase access to primary care, preventive services, and the substance abuse treatment system. Ann Emerg Med , 1997; 30:181-189.
• Primary Care Practices as “Brief Physician Advice” – Fleming, MF., Manwell, LB, Barry, KL, Adams, W, &
Stauffacher, EA Brief physician advice for alcohol problems in older adults: A randomized community-based trial. J Fam Pract; 1999 48(5): 378-84
SBIRT Today• Emergency Departments• Hospital Units• Primary Care Practices• Urgent Care• Federally Qualified Health Center • Health & Behavioral Health Clinic• Addiction Facilities • Educational Institutions • Community Service Settings
Health Care Providers can Provide SBIRT Services under Medicare
• Medicare pays for medically reasonable & necessary SBIRT services in physicians’ offices & outpatient hospitals
• Physicians, Physician Assistants, Nurse Practitioners, Clinical Nurse Specialists, Clinical Psychologists, or Clinical Social Workers can bill for SBIRT
• To bill Medicare, providers of MH services must be:– Licensed or certified to perform mental health services
by the state in which they perform the services;– Qualified to perform the specific mental health services
rendered; and– Working within their State Scope of Practice Act
http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/SBIRT_Factsheet_ICN904084.pdf
SBIRT Billing & Reimbursement
• Affordable Care Act Recommended Service
• Screening & Brief Intervention Reimbursement – Commercial insurance CPT codes– Medicare G codes– Medicaid HCPCS codes
• Florida has not approved Medicaid Billing Codes
• SAMHSA Block & SBIRT Grants
Payer Code DescriptionFee
Schedule
CommercialInsurance CPT
99408
Alcohol and/or substance abuse structured screening and brief intervention services; 15 to 30 minutes
$33.41
CPT 99409
Alcohol and/or substance abuse structured screening and brief intervention services; greater than 30 minutes
$65.51
Medicare
G0396
Alcohol and/or substance abuse structured screening and brief intervention services; 15 to 30 minutes
$29.42
G0397
Alcohol and/or substance abuse structured screening and brief intervention services; greater than 30 minutes
$57.69
Medicaid H0049 Alcohol and/or drug screening $24.00
H0050Alcohol and/or drug service, brief intervention, per 15 minutes $48.00
SBIRT Coding http://sbirt.samhsa.gov/coding.htm
CPT Code Description
90801 Diagnostic interview
90804 Individual psychotherapy, 20‒30 minutes
90806 Individual psychotherapy, 45‒50 minutes
Common Behavioral Health Codes
http://sbirt.samhsa.gov/about.htm
The Result:A 16-session curriculum manual for conducting brief treatment
(Dupree & Schonfeld, CSAT, 2005)
http://kap.samhsa.gov/products/manuals/pdfs/substanceabuserelapse.pdf
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