Addressing Substance Use as Part of Usual Care: Using SBIRT as a Foundational Approach in Pediatric and Specialized Patient Populations - Northwell Health will implement Screening, Brief Intervention, and Referral to Treatment (SBIRT) in 14 identified clinical sites to increase reach within unique populations. Sites will include 3 pediatric primary care practices, 3 pediatric emergency departments, 3 pediatric behavioral health urgent care centers, 3 community-based urgent cares that serve adults and pediatrics, and two adult pain management practices. These sites have been selected based on the needs of the populations they serve, including: a) pediatric patients in primary care; b) pediatric patients seen in other healthcare settings (who may not have a primary care provider (PCP)); c) adult patients, including young adults, seen at community based urgent cares (who may not have a PCP); and d) adults in PM practices who have a higher prevalence of substance use. Settings chosen will facilitate continuity of care efforts by addressing substance use as part of usual care across the lifespan, from pediatrics to geriatrics, accounting for diverse healthcare journeys patients travel, and will serve 140,000 in the five-year grant period. Clinical settings are located in diverse, densely populated regions of metropolitan New York, including New York City, Long Island, and Westchester, an area earliest and hardest hit by COVID-19. The need is greater now than ever to identify and address substance use as part of usual patient care as stay-at-home orders, social isolation, and a lack of in-person school has contributed to increased substance use. Our strategy is based on a foundation of SBIRT, with universal screening for all patients who enter the healthcare setting. Our implementation plan will be support by interdisciplinary champions, who will drive motivation and foster an environment for program sustainability. Patients with a positive screening will be offered a brief intervention, brief treatment, or a referral to treatment by a clinical team member trained to serve as an SBIRT Health Coach. Interprofessional team members will be offered training to serve in this role, to diversify their clinical skills and assist program sustainability. Referrals to treatment will include warm hand-offs to licensed treatment providers, including for medication for addiction treatment (MAT). MAT referrals will be facilitated for patients who receive MAT induction during their healthcare visit, and for patients who are not yet in withdrawal and need a next-day induction. Ongoing brief intervention and referral to treatment services will continue in partnership with Central Nassau Guidance & Counseling through Project CONNECT. A Project CONNECT navigator will reach out to patients within 24 hours of their healthcare visit, and at days 7, 30, 60, 90, 120, and 180, to offer ongoing services and support. Navigators will also provide information on sober housing, recovery support, AA/NA, and other resources to support sustained recovery. Through this model, we will complete all required GPRA data collection, and have an opportunity to assess additional measures over time. We will assess AOD use, engagement in substance use care/treatment, and conduct ongoing quality improvement activities to drive those measures in the direction of patient recovery.
