Providers at Frederick Memorial Hospital hope that a new screening tool will catch patients with risky substance use and get them into treatment faster.
The hospital implemented the SBIRT system — or Screening, Brief Intervention, and Referral to Treatment — shortly before the beginning of 2018, according to spokeswoman Melissa Lambdin. The brief screening is conducted by nurses for all patients, including those in the emergency room and those who have been admitted into the hospital.
“It’s just another tool we can use to identify individuals with risky substance use,” said Heather Kirby, vice president of integrated care delivery. “The initial screening is done by nurses, and if anyone is identified as positive, a referral is sent to our social work team and a peer recovery specialist, who will come and have a conversation with that patient.”
The goal of SBIRT is to alert patients to risky substance use before it results in more serious consequences, including illness, injury or arrest. The screening is meant to be brief — no more than five or 10 minutes, Kirby said — and includes questions on alcohol and illegal drug use.
Some of those questions ask about consumption, including how many days a week patients typically drink or whether they’ve ever used an illegal drug. Others address the impact of substance use on a patient’s life. Those include, “Have you ever felt guilty about your drinking or drug use?” and “Have you ever had a drink or used drugs first thing in the morning to steady your nerves?”
For the social workers and recovery specialists who follow up with patients, it’s important to assess the relative severity of substance use and cater treatment to those needs. The hospital partners with local Alcoholics Anonymous and Narcotics Anonymous groups to refer patients to meetings, said Nicole Wetzel, a social worker for FMH.
Members of those groups have volunteered to meet with patients, and Wetzel herself has directly transferred people to inpatient treatment facilities or coordinated phone interviews to begin the intake process. Sometimes, the intervention can be as simple as speaking to patients to gauge how serious they consider their substance use.
“We really want to meet with that patient and identify goals,” Wetzel said. “And that’s whether they’re looking for treatment, whether they’re first identifying that they might have a problem, or if they want to go straight into treatment after they’re discharged.”
While the goal of SBIRT is to identify risky use earlier on, Wetzel acknowledged that many patients go through the screening multiple times during frequent hospitalizations for substance abuse or addiction-related health issues.
In fiscal 2016, Frederick Memorial received more than 2,300 alcohol-related visits and 1,400 opioid-related visits — two of the most prevalent substances abused by patients, Wetzel said.
Still, experts say the screening can help by offering patients multiple opportunities to enter recovery. Wetzel pointed to one patient who entered treatment even after coming to the emergency room more than 100 times in one year for substance abuse-related issues.
“We’re talking many, many, many admissions, to the point where our staff thought there was nothing we could do, because we had literally done everything,” Wetzel said. “Well, lo and behold, our peer recovery specialist and I recently met with that patient. Fast forward, two and a half months later, and they’re clean. So, it’s a wonderful opportunity to show to our staff and clinicians that it’s never too late.”
Screening for substance abuse has become a priority across Maryland as the state allocates more resources toward the heroin and opioid crisis. In January 2017, Gov. Larry Hogan (R) announced $2.6 million in funding to expand SBIRT to six detention centers and five more hospitals throughout the state.
The Maryland Department of Health was awarded a five-year, $9.8 million grant from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) to implement SBIRT in 53 different medical centers.
The 2017 Heroin and Opioid Prevention Effort Act also required all hospitals to adopt protocols for discharging patients who come in for overdoses or screen positive for substance use disorders. Those protocols can include screening and coordination with peer recovery specialists, according to the language of the bill.
FMH did not receive grant funding to implement SBIRT at the hospital. But the health system did receive $120,000 — through the SAMHSA grant to the Maryland Department of Health — to implement the screening in primary care settings.
The grant will begin in July and include primary care offices with Monocacy Health Partners, a group of practices owned by the Frederick Regional Health System. Menocal Family Practice, a privately owned primary care office in Frederick, is also included.
The clinic already offers resources such as medication-assisted treatment for substance use disorders and medical testing needed to enter rehabilitation facilities, said Dr. Julio Menocal, the owner of the practice.
Roughly six to seven patients a day come in for those services.
“Joining the SBIRT program isn’t a huge deal, but any screening tool we can add is good,” Menocal said.
“I think it’s just a more formalized process we can use to detect the risk of addiction,” added Chris Haas, a nurse practitioner with the practice.
The Maryland Behavioral Health Administration states on its website that SBIRT in primary care settings can “normalize the conversation” on substance abuse and help patients “make choices that lead to better health.”
Both Menocal and Haas, though, were skeptical that the screening would persuade patients to enter treatment before they experienced the more serious consequences of addiction.
“People who aren’t in treatment are paddling toward a waterfall, but they don’t see the waterfall,” Menocal said. “That’s what makes these early interventions so tricky. Because until they fall off, they’re going to want to minimize their usage or tell you they don’t have a problem.”