Developing Sustainable Intervention Programs for Substance Use Disorders in Emergency Rooms

• Adapted Screening, Brief Intervention, and Referral to Treatment (SBIRT), an evidence-based intervention for substance use conditions, to screen Medicaid patients for alcohol and other substance use problems in primary care settings;

• Implemented the revised model at two primary care settings in the Bronx (Comprehensive Health Care Center, a federally qualified health center, and Bronx East, a patient-centered medical home) where more than 6,000 people were screened using SBIRT, of which nearly 500 received interventions or services as a result;

• Incorporated SBIRT screening tools and documentation into electronic health records to increase the number of patients screened and identified for additional services; and

• Developed a manual, toolkit, and other materials to facilitate adaption of SBIRT in primary care settings across the State.

Lessons & Opportunities:
CASAColumbia initially aimed to develop SBIRT for emergency room settings across the State. After further consultation with New York State Department of Health (NYSDOH) and other stakeholders, the project was revised for implementation in primary care settings. Better integrated care in primary care settings was deemed necessary because of the high prevalence of patients with substance use conditions that go unidentified in these settings. Lack of reimbursement to sustain SBIRT in emergency departments was also a barrier to implementing the project’s original goals. NYSDOH, however, was committed to providing reimbursement for SBIRT in primary care settings. Both primary care sites in the Bronx continue to use SBIRT to screen and identify patients and have expanded the model to additional sites.