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SBIRT Program

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Advancing the SBIRT Model into Rural Health Care

The Texas Tech University Health Sciences Center, School of Medicine (TTUHSC SOM) launched the RESeT West Texas program (Rural Education for SBIRT in West Texas) during the 2015-2016 academic year, following the f

The SBRIT model, which stands for Screening, Brief Intervention, and Referral to Treatment, was developed by the Substance Abuse and Mental Health Services Administration (SAMHSA; an agency of the Department of Health and Human Services) as an evidence-based brief intervention for people at risk for alcohol and drug problems. The mission of the TTUHSC SOM Rural SBIRT Training Program is to increase the availability of substance use treatment resources in our rural West Texas communities by training community physicians, primary care residents, medical students, and PhD students in Clinical Psychology in in the SBIRT model.

This project is a collaboration between The TTUHSC Department of Family and Community Medicine, TTUHSC Department of Medical Education (DOME), and the Texas Tech University Department of Psychological Sciences. This webpage is a repository for Rural SBIRT Training Program information and materials. Please stay tuned as this program develops.

RESeT Project Accomplishments as of March 2016

Rapid and successful implementation of the grant: The time between receiving confirmation of funds and the first SBIRT MS2 educational session was about 2 ½ months. During this time we met with key administrative stakeholders to gain support for the curriculum, spoke with course directors to secure curricular time, discussed the training with students to gain their perspective on the materials, generated SBIRT training materials, developed RESeT project logos to ensure project branding and visibility, launched and expanded the evaluation plan, and generally coordinated schedules across multiple professionals and systems in a very short time frame. These tasks were accomplished through hard work, creativity, and dedication from individuals listed on the grant, as well as several who volunteered their time. 

P3-2Successful integration of SBIRT into MS2 curriculum: We used multiple modalities to successfully integrate the SBIRT materials into the MS2 curriculum. Specifically, we used in-person didactics, role-playing, workshops, small group activities, online didactics, and simulated patients to provide SBIRT training. Training materials and activities were integrated into the following medical courses: Integrated Neurosciences (Modules 1-2); Patients, Physicians, and Populations (P3, Modules 3-7); Development of Clinical Skills (DOCS, SBIRT Standardized Patient Encounter). Inclusion in these courses allowed the materials to flow organically across the larger curriculum. Also, as multiple course instructors provided class time for our program, students received a clear and consistent message from their professors that this information is relevant and important to the practice of medicine. In total, 178 MS2 students received approximately 14 hours of SBIRT training.

P3-2Despite our accelerated timeline for implementing the MS2 curriculum, our materials received high satisfaction scores by the learners. The table below provides averaged ratings for key curricular elements.

2015-2016 MS2 Ratings (n = 77-175: Scale 1 (low/worst) to 5 (high/best)

Item

Average Rating

Quality of Content

4.0

Presentation Quality

4.1

Achievement of Learning Objectives

4.2

Usefulness to Medical Training

4.2

Importance to Medical Career

4.2

Quality of Opportunities to Practice Skills

4.5

 

Planning for the MS3 curriculum: We have begun the planning process to integrate SBIRT into the MS3 curriculum. As such, we have begun writing new policies for the Family Medicine Clerkship (where the curriculum will be housed), generating course materials, and gaining faculty support. We initially proposed recruiting 1 faculty champion in each of our regional campuses to insure the success of the MS3 curriculum. We have exceeded this plan by recruiting 6 champions from the Lubbock campus, 4 from the Permian Basin campus, and 2 from the Amarillo campus. We anticipate that these numbers will increase the sustainability of the project.  

Resident Curriculum: We have created what we believe will be a successful training model for our Family Medicine residents. This model will include in-person didactics, role-playing, and practice sessions. We began implementing this curriculum in early February, 2016 and plan to complete it in early March, 2016. To date, we have received positive feedback on this program (see below).P3 small group

2015-2016 Family Medicine Resident Ratings (Scale 1 (low/worst) to 5 (high/best)

Item

Average Rating

Usefulness of SBIRT to Medical Training

4.6

Importance of SBIRT to Medical Career

4.6

Expanded training opportunities for psychology graduate students: As outlined in the original grant application, we are training psychology graduate students in SBIRT alongside our Family Medicine residents. As stated above, this training has begun. Additionally, through a strong partnership with Texas Tech University (TTU; our sister campus) we have expanded the number of graduate student trainees from 8 to 15. We also expect to train 15 graduate students during years 2 and 3 of the project.

Enhanced SBIRT Training for Faculty: In our original application we proposed training faculty in SBIRT during our Annual Family Medicine CME Event. Additionally, we proposed sending 4 grant-supported faculty out of town for intensive training in Motivational Interviewing (MI; see original budget narrative), given that MI is a critical component of the SBIRT model. We have elected to combine these trainings. Specifically, we will be bringing in a MINT (Motivational Interviewing Network of Trainers) certified MI trainer for the Annual Family Medicine CME Event. This will allow us to offer enhanced SBIRT training (i.e. standard SBIRT training with intensive MI training) to 30 faculty from TTUSOM and TTU. This enhanced training will use a “train-the-trainer” model so that our faculty will be prepared to help the medical students hone their SBIRT skills. Further, we believe that this enhanced training delivered to such a large group of faculty will significant increase the sustainability of this project after funding has ended. This training began in mid-February, 2016 and will conclude during the Annual Family Medicine CME Event in early April, 2016. We notified our grand specialist and program official of this minor change. Our grant specialist informed us that this budget change did not require formal approval given that it is less than 25% of the approved budget. 

Regional recruitment events: To date we have had 2 faculty recruitment events in Amarillo and Odessa, Texas. With this recruitment we have substantially increased the number of faculty on these campuses who will receive SBIRT training, and will then supervise the MS3 SBIRT curriculum. We plan to extend our recruitment efforts to include rural community physicians in the coming months.

OSCEExpanded evaluation/assessment activities: In the reviews of our original application our data collection and performance measurement plan was categorized as “Outstanding.” We have successfully initiated our performance evaluation plan for all the program elements completed to date (see original application for program evaluation details). Further, we identified some additional areas for program evaluation since the program launched, and have expanded our evaluation plan accordingly. During the MS2 curriculum, we collected pre/post training recordings of students role playing MI skills, and will use the MITI (see original application for details on this measure) to evaluate their competency. Also, during the MS2 Standardized Patient Experience, we evaluated student’s Brief Negotiated Interview (BNI) skills using the BNI Competency Check List. Finally, during the resident and graduate students SBIRT training we will be evaluating this curriculum using the Attitudes to Health Professional Questionnaire (AHPQ), a standardized measure of attitudes toward working in interdisciplinary teams. We believe that these expanded evaluation efforts will help us improve our SBIRT training activities.OSCE orientation

Early Scholarship Activities: We believe strongly that scholarly activity is critical to a successful educational program. Therefore, we have already submitted preliminary program evaluation data to an international conference for alcohol researchers (decision pending). Further, we have generated a strategic plan to disseminate program evaluation data as it becomes available.

Free Clinic Planning and Enhancement: We have begun the process of generating a strategic plan for the TTUHSC Student-Run Free Clinic SBIRT program. Implementation of this program will be consistent with that described in the original application. However, we plan to enhance this program by providing intensive SBIRT training to the Medical Director (a Family Medicine physician) and the two Licensed Clinical Social Workers in the clinic. These professionals will be well positioned to supervise and enhance the SBIRT training for medical students, and to insure program sustainability after funding ends.

RESeT Scholarly Activities and Dissemination

Trotter, DRM, Littlefield, AK, Jones, B, Popp, L. (2016). INTRODUCING RESeT WEST TEXAS: RURAL EDUCATION IN SBIRT FOR WEST TEXAS. Poster Accepted to the Annual Conference of the Research Society on Alcoholism, New Orleans, LA.

RESeT Program Council of Directors

Name Role Responsibilities
David RM Trotter, PhD Project Director/ Council of Directors, Chair Overall project management, reporting to GPO, SAMHSA reporting
Betsy Jones, EdD Council Member Marketing and dissemination oversight
Simon Williams, PhD Council Member Oversight of medical student training
Fred Onger, MD Council Member Oversight of residency education
Randall Sheets, MD Council Member Oversight of faculty development & CME
Frank Babb, MD Council Member Oversight of MS3 SBIRT clinical experiences
Andrew Littlefield, PhD Council Member Motivational Interviewing Trainer and Program Evaluation
Lisa Popp, MD Council Member Oversight of MS2 didactics training
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