Conduct an Organization Assessment
You have to start somewhere, right?
We suggest that you start with an organizational assessment, assemble a team interested in making this happen, identify the stakeholders in your organization and determine the readiness of the organization to implement SBIRT. Once you get this far, you can get into the operational details. If you hit a wall, it may be worth trying in implement SBIRT in a much smaller unit in which you work, to gain experience and data to make a later approach to the leadership of your organization.
The organizational assessment need not be complicated. You basically need to ask around to find out what resources are available. For all you know, there may be many others who have received training like you have, are enthusiastic about the potential benefits of SBIRT, and can facilitate the work with you. You may simply be the first to take the initiative to get things moving.
What’s Being Done?
Is general health screening being done? You might be able to piggy back onto this. There may an SBIRT program in some part of the organization: perhaps the ED or the mental health system. Some of the work of setting up infrastructure or tapping the medical record system may have already been done. System leadership may already buy into the need for and advantages of SBIRT (for instance, the leaders may have come from a system that implemented SBIRT).
What is Available?
There may be training modules in use at your institution for parts of the SBIRT curriculum (and those we have created at IU are available for your use at www.iusbirt.org). Are there behavioral health specialists imbedded in the clinic where you work or are they geographically close by? What are the mental health services capacity of your system?
What’s the Organization’s Mood Regarding Change?
The notion of introducing SBIRT may play well if the organization has realized that substance abuse is contributing to quality of care issues, such as hospital readmissions or medication adherence problems. Accountable care organizations may be particularly interested in identifying and managing substance use problems because of the complications of substance misuse. A well-publicized tragedy (alcohol-related automobile accident, death of an undergraduate by alcohol poisoning, or domestic violence) might motivate an organization to begin to address this problem.
Are There Other Health Care Professionals Who have had Training in SBIRT Already, and Can Thus Be Your Allies?
This is an obvious benefit, but the question is how to identify them?
Perhaps a note in a medical or nursing staff newsletter, or, with permission, a question or two sent by way of the organizational email distribution system. You might wish to inquire about experience with training in or implementation of SBIRT, and interest in being part of the planning team.
Who are the Key Players?
As this will depend on your circumstances, it is important to first identify all the stakeholders and understand the role of each stakeholder in development & implementation of your plans (and anticipate that they will have important insights for you as well). Likely stakeholders include: clinic managers, supervisors of the outpatient department of the hospital, the practice managers for a private practice, and educational supervisors, as well as the leaders of the physician and nursing staff. In more complex systems (e.g., in hospitals at an academic health center), the hospital leadership (CEO, CMO, director of nursing services, director of mental health services, informatics officer, residency program director, etc.) need to at least tacitly agree with the benefits of implementing SBIRT and understand the changes that they will need to accommodate for the system.