Today, we’re interviewing Rachael Garbers and Lindsay Seccombe to hear more about their real-world experiences implementing SBIRT (Screening, Brief Intervention and Referral to Treatment).
Rachael currently is employed as a Wellness Specialist at Gundersen Health System Trauma services department. Lindsay is completing her preceptorship with Gundersen this semester. As preceptee (teacher) and preceptor (student intern), they work together to screen incoming trauma patients for behavioral risks, utilizing behavioral screening and intervention (SBIRT) practices.
To start, tell us about what you do and how you came to work as Wellness Specialists in Gundersen’s Trauma services department.
Rachael: For almost four years, I have worked as a Wellness Specialist at Gundersen Health System. I received motivational interviewing training under WIPHL’s previous grant and worked in family medicine before starting in trauma services. Here, I service all inpatients admitted with positive screens for at-risk alcohol consumption, tobacco, and/or illicit drug use.
Lindsay: I am a Wellness Specialist preceptee and work with Rachael to ensure maximum screening and intervention for Gundersen’s trauma patients. On a personal level, I am currently finishing my bachelor’s degree at University of Wisconsin-La Crosse. I have been accepted into a Master’s program for Public Health, and plan to continue on for medical school after that. Gundersen was an opportune facility to both gain experience and valuable one-on-one time with patients, which will make me a better doctor.
What is a typical day like in trauma services?
Rachael: Every morning, I begin my day running a screening report, which gives me a list of patients still needing to be screened and seen for the day. I also follow-up with patients via phone. Patients usually receive one-week, one-month, six-month, and one-year follow-up calls to provide them with additional assistance in making healthy lifestyle choices.
As a Wellness Specialist, you cannot directly prescribe medicine. What are some things you provide for patients?
Rachael: I am able to provide patients with compassionate care, opportunities for follow-up, and resources for help. This includes providing patients with recommendations and ways in which to promote their own health. Being that extra resource and support for patients is the one of the things I enjoy most about my job. Encouraging patients to take an active role in pursuing a healthy lifestyle is very rewarding.
How does Motivational interviewing (MI) fit in with what you do? Can you tell me a little more about what MI is?
Rachael: Motivational interviewing is the foundation for meeting with my patients. Being in a hospital bed can pose as a vulnerable time for people. It is often unexpected and can be life changing, that being said I do my best to put myself in the patient’s shoes.
Lindsay: Motivational interviewing provides us the opportunity to talk with patients about sensitive topics. Rachael and I use MI because it allows us to listen to patients. Many times in the health care field patients are told what to do and how to do it, without personalizing it. This often leaves patients frustrated and unsure about making changes. We collaborate with patients to meet them where they’re at. Giving patients the opportunity to actively participate in their own care can build confidence and promote change if the patient decides they are ready.
Is it difficult to work with patients who may need help but don’t necessarily want help?
Lindsay: I think that MI is especially important in these circumstances because again, our job is not to change people or force them to change. Learning MI has taught me to appreciate where people are at in their lives and that change doesn’t happen for everyone at the same time. With this mind set we are able to provide appropriate resources while respecting their autonomy.
Recently, the Wall Street Journal published an article about the benefit of using MI in clinical settings. What do you think of MI and its use in behavioral screening and intervention?
Rachael: MI is an efficient way to implement behavioral screenings and interventions in both clinical and inpatient settings, because it provides the opportunity to make a plan of action with the patient. My job helps bridge the gap between the provider and the patient. Being that the patients immediate needs are met by the providers, time can often be a barrier. As part of the healthcare team, I am able to help patients make further plans for change.
Lindsay: Taking the time to sit down with patients and engage in a conversation using MI gives us the opportunity to understand where the patient is at in regards to a healthy lifestyle. Rachael and I use MI to promote wellness without forcing information on the patients. By understanding what the patient is going through and where they are at in regards to making changes, or not, in their life helps us provide the most relevant information to benefit the patient.
Behavioral risks, like binge drinking, are extremely common in Wisconsin. How do you think BSI has the potential to change these common behaviors?
Lindsay: Being that Wisconsin has a high prevalence of at-risk alcohol consumption, we often see a significant amount of alcohol related traumas. Here at Gundersen we are taking those opportunities to educate, should the patient be open to it, about healthier lifestyle choices in an effort to prevent something worse from happening.
Rachael: Providing SBIRT services does help change the culture of risky drinking – it really just ties in beautifully to what we do and hope to continue doing.
By Richard L. Brown, MD, MPH
One of the exciting aspects of serving as the WIPHL’s director has been witnessing the rapid growth and depth of support for healthcare settings to deliver behavioral screening and intervention (BSI). In just the past few months, there has been several important policy developments regarding the recommendation and delivery of alcohol and drug screening, brief intervention and referral-to-treatment (SBIRT), both on a national and state level.
Every year, the White House and Director of the Office of National Drug Policy (also known as the “drug czar”) release an update of the nation’s strategy to address its drug problems. Chapter two of the newly-released National Drug Control Policy of 2013 is titled “Seek Early Intervention Opportunities in Healthcare” and details steps the federal government is taking to promote delivery of SBIRT. These efforts include promoting better education for healthcare professionals, enhancing fee-for-service reimbursement for services, and updating educational resources. The document cites WIPHL and its partnerships with universities and employers as a “model public-private collaboration.”
Toward enhancing the delivery of SBIRT services, the Center for Medicare and Medicaid Services recently released a plan to update its rules on reimbursing hospitals for services delivered to Medicare patients. An exciting aspect of the plan is to require hospitals to report to Medicare the proportion of Medicare patients who have received SBIRT services and to institute strong financial incentives based on quality metric reporting. This aspect of the proposal would be implemented in 2016, which gives hospitals liberal lead time to plan how they will deliver these services.
Finally, at the state level, Wisconsin’s State Council on Alcohol and Other Drug Abuse (SCAODA) is charged with making recommendations to the Governor and legislature on preventing and addressing alcohol and drug problems in our state. SCAODA will soon consider adopting its subcommittee recommendations intended to help make BSI a routinely delivered service in primary healthcare settings, emergency departments and hospital inpatient units throughout the state. Recommendations include eliciting the support of the Governor’s Office in convening representatives of private and public healthcare purchasers, and requiring payers to publicize fee-for-service reimbursement policies for behavioral screening and intervention.
Also at the state level, the Wisconsin Department of Health Services submitted a grant application to the US Substance Abuse and Mental Health Services Administration for approximately $8 million to continue disseminating alcohol, drug, tobacco and depression screening and intervention in primary care clinics throughout the state. The Wisconsin Primary Health Care Association (WPHCA) would be a lead organization in this project. Although WPHCA serves as an umbrella organization for Wisconsin’s federally-qualified health centers, all primary care clinics will be invited to participate. Notification of a funding decision will likely come in the early fall, and service delivery will start at some clinics by early 2014.
These exciting developments are further evidence of momentum for behavioral screening and intervention. If your clinic and hospital aren’t yet delivering BSI, they will in the future. Please contact WIPHL if you have any questions on how to get BSI started in your clinic or hospital, or on what you can do to accelerate implementation of evidence-based, cost-saving BSI in your community.