Why we are recommending this best practice
Strategies for implementation
- Identify and train the appropriate staff for screening and brief intervention techniques. This can include sample scripting for staff around screening itself and how to respond to positive screens and is applicable to any type of screening completed. Refer to Best Practice 7 for more information on Trauma-Informed Care and how to avoid re-traumatization.
- Have a list of resources or informational packets available for each American Society of Addiction Medicine (ASAM) level of care to support women at all levels of risk.
- Establish a clear system and workflow for positive, validated screening and/or assessment tools.
- Please see the Resources section of this Best Practice for information on risk (“AIM Opioid Screening Tools”).
- Low risk patients can receive brief advice related to their identified substance.
- Moderate risk patients should have a brief intervention
- As described in Best Practice 1, after a positive screen for SUD, use a validated assessment tool to determine the presence and severity of the SUD followed by the identification of the appropriate level of care to match the severity of the patient’s needs. The state of California mandates that all counties with Drug Medi-Cal Organized Delivery System (DMC-ODS) contracts use the ASAM criteria to determine the appropriate level of care for an individual with SUD. The ASAM Co-triage or the ASAM Continuum clinical decision supports are ideal assessment tools to meet that requirement.
- Other than the Co-triage, which is designed as a ten-minute provisional evaluation tool, each assessment typically takes an hour to complete. Identifying clinic personnel who can be trained to effectively administer the chosen screen, assessment, and level of care evaluation prior to SBIRT implementation will streamline workflow.
- Identify local options for each level of care, including the full spectrum of office-based treatment (level 1), methadone clinic management (level 1 OTP), intensive outpatient centers (levels 2.1 and 2.5), residential treatment centers (levels 3.1, 3.3, 3.5, and 3.7) and medically managed inpatient treatment (level 4). Please see the Resources section of this Best Practice for the SAMHSA treatment locator tool. For more on levels of care, please refer to the toolkit section titled The Current State of the Addiction Treatment Ecosystem.
- Referral sites may be any of the above depending on the level of care determined to be most appropriate.
- SAMSHA’S guide to SBIRT.
- ASI (Addiction Severity Index) Sample.
- ASAM Continuum - Guide to Levels of Care for Substance Use Treatment.
- NNEPQIN Toolkit for Perinatal Care of Women with Substance Use Disorders. Chapter 3 on SBIRT.
- SBIRT Oregon’s online curriculum guide to teaching and using SBIRT.
- AIM Opioid Screening Tools.
- Behavioral Health Treatment Services Locator.
- Wright TE, Terplan M, Ondersma SJ, et al. The role of screening, brief intervention, and referral to treatment in the perinatal period. AJOG. 2016;215(5):539-547. doi:10.1016/j.ajog.2016.06.038. https://www.ncbi.nlm.nih.gov/pubmed/27373599.