September 2009: The Indiana University School of Medicine, Wishard Health Services and Midtown Community Mental Health Center are awarded a five-year SBIRT Medical Residency grant through SAMHSA (Substace Use and Mental Health Services Administration).
October 2009: IU SBIRT adds the Indiana Prevention Resource Center, a research, substance use prevention and substance use treatment advocacy agency, and The Academic Edge, an educational media development company, are integrated into the grant becoming partnering institutions.
October 2009: Principal Investigator, Dr. David Crabb, calls for administrators from partnering institutions to meeting bi-monthly to establish IU SBIRT.
December 2009: Joseph Bartholomew, MSW, is hired as SBIRT Program Coordinator.
December 2010: Lisa Session, BSW, is hired as SBIRT Counselor for the Primary Care Center 4 pilot site.
February 2011: SBIRT Screening begins at the Primary Care Center 4 pilot site.
Interns will receive their face-to-face SBIRT training in their PGY-1 year. The SBIRT face-to-face training involves involves a brief introduction and overview of SBIRT and counseling approach of Motivational Interviewing (MI). The face-to-face SBIRT training last approximately four hours and the training location is on the IUPUI campus. Prior to the face-to-face training, interns are required to complete Course 1 web-modules, located at www.iusbirt.org, prior to their face-to-face training. PGY-2 and PGY-3 residents will also receive further SBIRT training by completing Course 2 and Course 3 web-modules at www.iusbirt.org during their respective second and third years of residency.
Motivational Interviewing (MI) is based upon four general principles: express empathy, develop discrepancy, roll with resistance, and support self-efficacy.
The spirit of Motivational Interviewing can be even further characterized in a few key points
- Motivation to change is elicited from the client, and is not imposed from outside forces
- It is the client’s task, not the counselor’s, to articulate and resolve his or her ambivalence
- Direct persuasion is not an effective method for resolving ambivalence
- The counseling style is generally quiet and elicits information from the client
- The counselor is directive, in that they help the client to examine and resolve ambivalence
- Readiness to change is not a trait of the client, but a fluctuating result of interpersonal interaction
- The therapeutic relationship resembles a partnership or companionship
Motivational Interviewing is a counseling approach in part developed by clinical psychologists Professor William R Miller, Ph.D. and Professor Stephen Rollnick, Ph.D. Motivational interviewing is a semi-directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. Compared with non-directive counseling, it’s more focused and goal-directed. Motivational Interviewing is a method that works on facilitating and engaging intrinsic motivation within the client in order to change behavior. Therefore, Motivational Interviewing is an approach that can be used during the brief intervention ‘BI’ portion of the SBIRT process. Remember that brief intervention focuses on increasing insight and awareness regarding substance use and motivation toward behavioral change.
Midtown Community Mental Health Center is Wishard Health Services’ addictions services provider. Midtown is licensed by the State of Indiana as a community mental health center and addictions service provider. As a licensed mental health center, Midtown provides state-of-the-art care to patients. Our treatment philosophy is known as the recovery model, emphasizing the strengths and resources each person brings to the challenge of resuming a fully productive life. Midtown treatment options are Outpatient Addictions Treatment, Outpatient Detox, Project Home, Dual Diagnosis, Adolescent Addictions, and Narcotics Treatment Program (NTP). Visit www.wishard.edu/our-services/midtown-community-mental-health/addiction-services for further information.
Substance Abuse and Mental Health Services Administration (SAMHSA) is a branch of the U.S. Department of Health and Human Services. It works to improve the quality and availability of substance abuse prevention, alcohol and drug addiction treatment, and mental health services. Visit www.samhsa.gov for more information.
There are 17 medical residency SBIRT programs across the nation. From Boston to San Francisco and Indianapolis to San Antonio, SBIRT is set to become a fixture in medical residency programs. Check out www.samhsa.gov/prevention/SBIRT/index.aspx to learn more.
There are two distinct levels in substance abuse treatment, inpatient and outpatient:
- Medically Monitored Inpatient Detox
- Medically Managed Inpatient Detox
- Intensive outpatient
- Partial Hospitalization
- Halfway House
- Medically Monitored Residential – Short term
- Medically Monitored Residential – Long term
- Medically Managed Residential
- Methadone Maintenance Clinic
- Self-help Groups
Treatment Levels of Care
When considering the level of care to which you should refer your patient, consider the following caveats:
- Match patients to the least restrictive treatment environment that will be safe and effective.
- Assure that gains made in intensive settings are maintained by smooth access to less structured levels of care as the patient develops the capacity and motivation necessary to maintain behavior change.
- Remember that patient may sometimes move from less structured to more intensive treatment settings as lack of improvement or more hazardous behavior necessitates a higher level of care.