Scaling Mental Health and Substance Use Training for Health Professionals

Today, substance use – alcohol, tobacco, illegal drugs, prescription drugs – causes more deaths, illnesses, and disabilities than any other preventable health condition. Drug-related deaths have more than doubled since 2000.
Substance use disorders are common, but treatable. However, many Americans may not seek treatment for substance use, and only 11% of Americans with a substance use disorder receive treatment. Early intervention by health professionals is critical to reduce substance use mortality and motivate those engaging in risky behavior to make a change.

Screening, brief intervention, and referral to treatment, also known as SBIRT, is an evidence-based approach for health professionals to provide substance use intervention. Early intervention involves universal screening by healthcare providers at any entry point for patients into the medical system such as primary care, the emergency department, and inpatient settings.

A Public Health Approach for Managing Substance Use

Research shows that SBIRT is a healthcare delivery approach that has public health impact potential. SBIRT is defined as a comprehensive, integrated, public health approach to the delivery of early intervention for individuals with risky alcohol and drug use, and the timely referral to more intensive substance abuse treatment for those who have substance abuse disorders. 

• Screening quickly assesses for the presence of risky substance use, follows positive screens with further assessment of problem use, and identifies the appropriate level of treatment.

• Brief intervention focuses on increasing insight and awareness regarding substance use and motivation toward behavioral change.

• Referral to treatment provides those identified as needing more extensive treatment with access to medications, primary care counseling or specialty care as needed by the patient.

Beginning in the 1980s, more than 100 clinical trials were conducted to evaluate alcohol screening and brief intervention in primary care and other settings. This same implementation research was translated for tobacco, illicit drugs, and prescription drugs in the 90s. Brief interventions have been shown to improve outcomes – “irrefutable” in the short-term, remaining to be demonstrated in the long-term.

Benefits of Screening and Brief Intervention

By capturing patients engaging in risky substance use or in need of treatment, SBIRT contributes to quality improvement in the healthcare system. Substance use that would otherwise contribute to chronic illness, mental health problems, and other social consequences can be avoided.

SBIRT services are reimbursable and cost-effective tools for tackling the substance use epidemic. Today, screening and brief intervention services qualify for reimbursement by public and private insurance in all states. Studies have also shown that investing in SBIRT training for nurses, physicians, counselors, therapists, social workers and pastoral care workers can result in healthcare cost savings ranging from $3.91 to $5.60 for each dollar spent on training. Furthermore, providing brief intervention in the primary care setting averts the higher cost of providing these services in a specialty care setting.

A Gap in Substance Use Intervention Training

SBIRT is an approach that is relatively simple to learn compared to lengthier specialized training necessary for other behavioral health interventions. And, it can be implemented by diverse groups of health professionals including physicians, nurses, social workers, health educators, and paraprofessionals.

Despite evidence that SBIRT better serves patients and benefits the health system, training in SBIRT for health professionals is lacking. Curricula for students and continuing education for practicing health professionals varies widely. In nursing, for example, only 10% of schools require competency in screening and brief intervention in B.S. curricula. The majority of Masters of Social Work programs do not require any courses on substance use and addiction, nor do they provide training about SBIRT. It remains unclear to what extent SBIRT is integrated into curricula for students in medical, physician assistant, and pharmacy programs.

For practicing professionals, a survey of health professionals found that the majority do not feel prepared to screen patients, use motivational interviewing, or collaborate on an action plan with patients.

To encourage healthcare professionals to conduct SBIRT, SAMHSA has funded several programs across colleges and universities, medical residency and professional training programs, and state agreements since 2003.

A Partnership for Substance Use Training

A growing movement is focusing on all medical, nursing, and social work students to be educated on basic competencies for identifying and addressing the needs of individuals at risk for and diagnosed with substance use disorders.

Since 2014, NORC at the University of Chicago has partnered with the Council on Social Work Education (CSWE), the Center for Clinical Social Work (CCSW), the American Association of Colleges of Nursing (AACN), Institute for Research, Education, and Training in Addictions (IRETA), and Kognito to address adolescent substance use. The coalition has engaged nursing and social work schools, and their accrediting bodies, in a learning collaborative to develop, evaluate, and disseminate interactive, competency-based substance use SBIRT curriculum. The partnership is made possible with funding from the Conrad H. Hilton Foundation.

As of 2018, over 60 academic institutions have implemented the curriculum, resulting in over 5,500 individuals trained with Kognito’s SBI with Adolescents simulation. Now in its second phase, the project aims to train 12,000 students, field instructors, preceptors, and practitioners using the core curriculum.

Simulated-Based Training for Substance Use Interventions

With the right resources, SBIRT training can be easily integrated into:

• health professions curriculum in a classroom setting
• nursing and medical residency programs within health systems
• professional development portfolios for nurses and other health professionals
• self-directed practice with continuing education credit for health professionals

Kognito’s approach to SBIRT training doesn’t stop at explaining what SBIRT is, but rather it gives each learner practice conducting SBIRT using self-directed simulation. Together with leading subject matter experts, our SBIRT simulations were designed to build healthcare professional skills, confidence, and efficacy in patient communication and engagement. When it comes to brief interventions, training in evidence-based motivational interviewing techniques is crucial for driving patients towards change.

Kognito has incorporated SBIRT training into four clinical communication simulations, which are accredited for CME/CNE/NASW credits. These simulations allow healthcare professionals to practice evidence-based motivational interviewing techniques and conduct SBIRT with emotionally-responsive virtual patients to improve their real-world efficacy.

• SBI Skills Assessment and SBI with Adolescents train nurses, physicians, social workers, and students to apply evidence-based techniques to screen for substance use, conduct brief interventions, and coordinate referrals to treatment with adolescent and adult patient populations.
• At-Risk in Primary Care and At-Risk in Primary Care: Adolescents cover topics including opioids, alcohol, depression, and suicidality to improve the capacity of health professionals to address mental health and suicidal ideation as part of routine care.

Better Training, Better Patient Outcomes

The advantage of training with simulations is streamlined, cost-effective learning that allows healthcare professionals to practice conversation techniques with emotionally-responsive virtual humans and receive personalized feedback in real-time.

A study at Saint Louis University School of Nursing, which implemented SBI for Adolescents into its curriculum, showed increased competency and skills related to delivering SBI with adolescents among its nursing students. For example, there was a 90% increase in competency to tailor brief interventions to adolescents’ motivational level after completing the simulation.

Across Kognito’s SBIRT simulations, 75% of healthcare providers report that the simulation had a positive impact on patient communication. Research has shown that these simulations result in statistically significant increases in preparedness and self-efficacy to apply communication skills around SBIRT.

Fifty percent report an increase in the number of conversations with patients about substance use. And users report increases in the number of patients screened, brief interventions conducted, and referrals to behavioral health treatment.

Increasing access to SBIRT training through curriculum integration in curriculum and as an accreditated resource for practicing healthcare professionals is a simple intervention with major potential. The skills improvements and behaviors that result from SBIRT training translate into more patients getting the care they need, mitigating more serious consequences down the line and improving public health.

Interested in SBIRT training? Learn more here.