MADISON – Five Wisconsin healthcare clinics will now offer behavioral screening and intervention (BSI) services aimed at reducing unhealthy drinking and drug use, promoting smoking cessation and improving depression detection and treatment. BSI screens all patients in general healthcare settings for alcohol, drugs and other behavioral risks. Administered by a trained health educator, BSI is proven to reduce alcohol and drug use – the fourth leading cause of death in Wisconsin – and healthcare costs.
The Wisconsin Initiative to Promote Healthy Lifestyles (WIPHL) finished training seven new health educators to deliver BSI at these five clinics. Health educators meet with patients who screen positive on questionnaires for alcohol, drug use and other behavioral risks and conduct further assessment to deliver interventions or make referrals, as appropriate. They receive a two-week, comprehensive training lead by WIPHL and are a cost-efficient, dedicated addition to the health care team. There are now 20 clinics in Wisconsin that have health educators on staff to deliver BSI in a sustainable manner.
This new group of health educators will be working at:
- Family Health / La Clinica, Wautoma
- Sargeant Internal Medical Clinic, Medical College of Wisconsin, Wauwatosa
- Richland Medical Center, Richland Center
- University Health & Counseling Services, University of Wisconsin-Whitewater, Whitewater
- Watertown Area Cares Clinic, Watertown
“As a health educator at a rural clinic in Northern Wisconsin, I’ve seen first-hand the help many patients need – and more importantly, want – to make positive lifestyle changes,” said Brittany Innes of Family Health / La Clinica. “Wisconsin is known for their above average levels of alcohol and drug use. After last week’s training, I now have the ability to go back to my clinic and help our patients get the critical assistance they need to address binge drinking, drug use, smoking and depression as well.”
WIPHL is a grant-funded program of the University of Wisconsin-Madison’s School of Medicine and Public Health that helps healthcare settings systematically implement BSI and train the important health educators who help deliver the service. For more information, visit www.wiphl.org.
A health educator who delivers SBIRT services in a Wisconsin healthcare clinic tells the story of how a brief intervention resulted in her patient getting much-needed mental health and financial help. (Some details have been changed to protect patient confidentiality.)
A patient with severe depression came into our clinic but declined to fill out the brief screen questionnaire before her appointment. After meeting with her, the provider asked me to meet with her, because she was struggling with her mood. I gently approached the patient, who was in tears. We talked a little bit, and she agreed to answer the screening and brief assessment questions. We completed them together and discussed her results.
The patient’s score on the brief assessment (PHQ-9) indicated severe depression severity, and I encouraged the patient to see a mental health counselor, but the patient said she had been to one before and didn’t feel like it helped. She was tearful and said that she didn’t usually share her feelings and felt bad for crying. I just tried to support her and meet her where she was at. We discussed other things she could do on her own – behavioral activation activities – and we also discussed talking with her provider about a change in her medication.
At the end of our time together, I reiterated that we have a great mental health counselor on staff right here at the clinic, and if the patient was ever interested, I could set it up for her to have an appointment. The patient did end up seeing the counselor, and shortly after, the counselor came back to me to let me know that the patient was doing extremely well.
The provider switched the patient to another medication that worked better for her; she has engaged in counseling; and is now feeling much better. She told her counselor that she never would have felt well enough and comfortable enough to go to counseling if she hadn’t met with me (the health educator) for a brief intervention first.
Even though this patient initially declined to fill out the brief screen, an engaged and persistent team made sure she got access to BSI services – which in turn helped connect this patient with the services that best met her needs.
By Mia Croyle, MA
During the behavior change process, a skillful practitioner does not rely solely on his or her authority, expertise and knowledge to provide the motivation for a patient to make changes. Rather, the practitioner holds back on theirown expertise, using it strategically and not before the patient is ready to receive it.
Here are some tips on how you, the practitioner, can tell when a patient is ready to receive information that you have to share and how to make sure the patient stays engaged and empowered while you share it.
- The person asks for the information – if the patient asks you for information, that is usually a clear and obvious sign that he/she is interested in hearing what you know. Be sure to provide the information in small, digestible bites and check in with the patient for his/her understanding and reactions to the information.
- You ask permission to share the information – permission asking allows us the check in with the patient in a transparent way and shows that you respect their autonomy. You’ll rarely get a “No,” but be prepared to respect it if you hear it.
Can I share some information with you?
Is it okay with you if I tell you what we know?
- You reinforce the patient’s autonomy in regards to how to respond to the information
This may or may not work for you….
What you decide to do with this information is up to you…
By Richard L. Brown, MD, MPH
I hope you and your loved ones had very happy holidays. Unfortunately, many Americans didn’t – and that’s because of drunk driving. During most of December, 28 percent of traffic fatalities in the United States involve an intoxicated driver. But between Christmas and New Year’s, that rate climbs to a staggering 40 percent.
According to the National Institute on Alcoholism and Alcohol Abuse, “two to three times more people die in alcohol-related crashes than during comparable periods the rest of the year.” And more than one-third of those who die are not intoxicated.
In Wisconsin, the problem is particularly concerning as we lead the nation in the proportion of adults who anonymously report driving drunk. In 2011, the most recent year in which data is available, there were 184 alcohol-related fatalities on Wisconsin roads.
What can we do about this?
Typically, one suggestion is to increase drunken driving penalties. Wisconsin is one of the few states in the country where first-time drunk driving is not a misdemeanor conviction. Unfortunately, while stiffening penalties would send a long, overdue message that drunk driving is not to be tolerated, research has shown stiffer penalties seldom deter illegal behaviors when most individuals do not believe that they will be caught. Therefore, a measure that is more likely to deter drunk drivers is to expand sobriety checkpoints, because checkpoints increase the perceived likelihood of apprehension. This would necessitate changing Wisconsin state law, which currently prohibits sobriety checkpoints even when localities would like to implement them.
Another typical suggestion is to clamp down on repeat offenders. For example, every U.S. state has some version of an ignition interlock law. Requiring ignition interlock devices does not eliminate drunk driving but does substantially reduce it. However, most drunk drivers involved in fatalities are not repeat offenders. A comprehensive strategy must also reduce drunk driving by those who have never been caught before.
The following graph illustrates the problem:
About two-thirds of the differences in rates of drunk driving across states can be attributed to differences in rates of binge drinking. This finding suggests that we will not substantially decrease drunk driving and related fatalities and injuries in Wisconsin unless we decrease binge drinking.
Decreasing binge drinking may sound challenging, but all that is needed is the political will to implement policies and programs that have been proven to work in many other places across the U.S., including reducing alcohol access and raising alcohol prices through higher excise taxes. See healthfirstwi.org and collegedrinkingprevention.gov for more information.
And of course, systematic delivery of SBIRT in clinics and hospitals would also help decrease binge drinking. One study in Wisconsin primary care clinics found that brief interventions reduced car crashes among binge drinkers by 50 percent the following year.
So, as this year’s holiday season fades, let’s stiffen our resolve to prevent the deaths and injuries that we can inevitably expect next holiday season and throughout the year. Please join me in a New Year’s resolution to do whatever possible to make SBIRT routine in Wisconsin healthcare settings.