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.
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.