UNASSIGNED: Screening, brief intervention, and referral to treatment (SBIRT) for adolescent alcohol and drug (AOD) use is recommended to occur with adolescents admitted to pediatric trauma centers. Most metrics on SBIRT service delivery only reference medical record documentation. In this analysis we examined changes in adolescents\' perception of SBIRT services and concordance of adolescent-report and medical record data, among a sample of adolescents admitted before and after institutional SBIRT implementation.
UNASSIGNED: We implemented SBIRT for adolescent AOD use using the Science to Service Laboratory implementation strategy and enrolled adolescents at 9 pediatric trauma centers. The recommended clinical workflow was for nursing to screen, social work to provide adolescents screening positive with brief intervention and referral to their PCP for continued AOD discussions with those. Adolescents screening as high-risk also referred to specialty services. Adolescents were enrolled and contacted 30 days after discharge and asked about their perception of any SBIRT services received. Data were also extracted from enrolled patient\'s medical record.
UNASSIGNED: There were 430 adolescents enrolled, with 424 that were matched to their EHR data and 329 completed the 30-day survey. In this sample, EHR documented screening increased from pre-implementation to post-implementation (16.3%-65.7%) and brief interventions increased (27.1%-40.7%). Adolescents self-reported higher rates of being asked about alcohol or drug use than in EHR data both pre- and post-implementation (80.7%-81%). Both EHR data and adolescent self-reported data demonstrated low referral back to PCP for continued AOD discussions.
UNASSIGNED: Implementation of SBIRT at pediatric trauma centers was not associated with change in adolescent perceptions of SBIRT, despite improved documentation of delivery of AOD screening and interventions. Adolescents perceived being asked about AOD use more often than was documented. Referral to PCP or specialty care for continued AOD discussion remains an area of needed attention.
UNASSIGNED: Clinicaltrials.gov NCT03297060.

BACKGROUND: Pediatric trauma centers have had challenges meeting the American College of Surgeons criteria for screening and intervening for alcohol with adolescent trauma patients. The study objective was to conduct an implementation trial to evaluate the effectiveness of the Science to Service Laboratory (SSL) implementation strategy in improving alcohol and other drugs (AOD) screening, brief intervention, and referral to treatment (SBIRT) delivery at pediatric trauma centers.
METHODS: Using a stepped wedge cross-over cluster randomized design, 10 US pediatric trauma centers received the SSL implementation strategy to deliver SBIRT with admitted adolescent (12-17 years old) trauma patients. The strategy adapted three core SSL elements: didactic training, performance feedback, and facilitation. The main outcome measured was SBIRT reach. Data were collected from each center\'s electronic health record (EHR) during pre- and post-implementation wedges (2018-2022).
RESULTS: EHR data from 8461 adolescent patients were extracted. Aggregated across all sites, the reach of screening with a validated AOD screening tool increased significantly from 25.2% (95% CI: 23.9, 26.5%) of adolescents during pre-implementation to 47.7% (95% CI: 46.3%, 49.2%) post-implementation. There was variability of change across centers. Brief interventions continued to be delivered at high levels to identified adolescents. Referral to primary care providers for further AOD discussion or referral to specialty service for adolescents with high risk use did not improve post-implementation and remained low.
CONCLUSIONS: The SSL implementation strategy can be successfully utilized by pediatric trauma centers to improve AOD screening, but challenges exist in connecting adolescents for continuation of AOD discussions after discharge.
METHODS: Level II, Therapeutic.

Risky substance use can lead to a variety of negative health outcomes, yet treatment is often underutilized by historically minoritized racial/ethnic groups. Screening, Brief Intervention and Referral to Treatment (SBIRT) is effective in changing substance use patterns across diverse settings and for diverse demographic groups. However, few studies have focused on whether individuals receive the appropriate level of care based on screening criteria. The purpose of this study was to investigate intervention match/mismatch and factors (e.g., service site, gender, race, ethnicity, age, socio-economic status) that predicted the likelihood of being matched/mismatched to an intervention. A sample of N = 3412 were available for analyses and logistic regressions were performed to examine the relationship between matching/mismatching to an intervention and other factors. Of participants, 2222 (65%) were matched to an intervention and 1190 (35%) were mismatched to an intervention. Being older, Hispanic, and receiving SBIRT by health-teams designed to reduce health disparities was related to increased odds of being mismatched. Exploratory results suggested that across predictors, individuals were more likely to receive a lesser intervention than their screening score indicated. Most clients were matched well to intervention as based on screening score. When mismatch occurred, a lower level of care was given. Staff may benefit from attending to more client engagement so that clients return for more intensive interventions; and agencies may need more resources to facilitate client access to services.

UNASSIGNED: Addictive disorders are significant global public health burdens. Treatment uptake with these disorders is low and outcomes can be mixed. Electronic screening, brief intervention, and referral to treatment (e-SBIRT) programs have potential to improve uptake and treatment outcomes. To date, however, no prior review of the literature has been conducted to gauge the effectiveness of e-SBIRT for addictive disorders.
UNASSIGNED: We conducted a systematic review and meta-analysis of the literature concerning e-SBIRT for addictive disorders by surveying the MEDLINE, PubMed, Web of Science, Scopus, Embase, and PsycInfo databases on January 17, 2023.
UNASSIGNED: Ten articles were included at analysis reporting evaluation of e-SBIRT interventions for substance use disorders including alcohol use in a variety of settings. No articles were identified regarding treatment for behavioral addictions such as disordered/harmful gambling. Meta-analysis found e-SBIRT to be effective at reducing drinking frequency in the short term only. e-SBIRT was not found to be advantageous over control conditions for abstinence or other treatment outcomes. We identified and described common components of e-SBIRT programs and assessed the quality of available evidence, which was generally poor.
UNASSIGNED: The present findings suggest that research regarding e-SBIRT is concentrated exclusively on higher-risk substance use. There is a lack of consensus regarding the effectiveness of e-SBIRT for addictive disorders. Although common features exist, e-SBIRT designs are variable, which complicates identification of the most effective components. Overall, the quality of outcome evidence is low, and furthermore, high-quality experimental treatment evaluation research is needed.

UNASSIGNED: The objectives were to examine students\' experience, perceived student norms, and perceived campus norms regarding web-based SBIRT based on substance use risk level.
UNASSIGNED: One hundred forty-three students completed an alcohol SBIRT program and survey, and 80 students completed a cannabis SBIRT program and survey.
UNASSIGNED: Undergraduates were recruited through campus-wide emails and a research management system.
UNASSIGNED: The majority of students found the SBIRT programs to be understandable, comfortable, and useful. Students reporting moderate/high-risk alcohol use were less likely to believe the information in the SBIRT program (X2 (1, N = 143) = 16.334, p < .001). Students with moderate/high-risk cannabis use were less likely to indicate that students on campus would be open to taking the web-based SBIRT (X2 (1, N = 80) = 7.680, p = .006).
UNASSIGNED: Understanding students\' experience and perceived norms regarding web-based SBIRT can inform efforts to utilize this approach as part of campus prevention efforts.

UNASSIGNED: The management of alcohol-related liver disease requires a multidisciplinary approach to treat alcohol use disorder. We aimed to determine the proportion of actively drinking patients admitted for alcohol-associated hepatitis (AAH) or decompensated alcohol-related cirrhosis (DARLC) who were offered or underwent screening, brief intervention, and referral to treatment (SBIRT) for alcohol use disorder during admission and if inpatient SBIRT is associated with reduced readmissions for alcohol-related liver disease.
UNASSIGNED: We conducted a retrospective cohort study of actively drinking patients admitted to our institution from January 2017 to December 2021 with AAH or DARLC. Logistic regression was used to identify factors, such as conducting SBIRT, that were associated with 30-day and 90-day readmissions for recurrent AAH or DARLC.
UNASSIGNED: There were 120 AAH admissions (mean age 47.7 ± 13.6 years), and 177 DARLC admissions (mean age 58.2 ± 9.5 years). SBIRT was conducted in only 51.7% of AAH admissions, and 23.7% of DARLC admissions. For AAH, conducting SBIRT was associated with significantly reduced 30-day (OR 0.098, P = 0.001, 95% CI 0.024-0.408) and 90-day (OR 0.166, P = 0.003, 95% CI 0.052-0.534) readmissions. For DARLC, there was no association between conducting SBIRT and 30-day or 90-day readmissions.
UNASSIGNED: SBIRT was conducted with actively drinking patients in only 51.7% of AAH admissions and 23.7% of DARLC admissions. Patients admitted for AAH who received inpatient SBIRT had decreased 30-day and 90-day readmission rates for AAH or DARLC.

Background: While human ecosystem disruptions have happened in the past, the COVID-19 pandemic is the first situation to warrant such a large, world-wide transition to online education. The pandemic has increased the need for intervention with people in varying stages of substance use disorders.Objectives: In response to the need for more evidence-based, online educational and training options to address this need, this study used pre-posttest evaluations to determine the efficacy of an online training for a specific evidence-based intervention, Screening, Brief Intervention, and Referral to Services (SBIRT).Methods: Social Work students from two universities completed a 4-hour, online training in SBIRT which included a pre/posttest, demographic variables, a satisfaction scale, and a measure of self-efficacy. Mixed Effects Linear regression was used to model the repeated measures of SBIRT knowledge and efficacy, while a linear regression model was used to measure the relationship between satisfaction and participant characteristics.Results: Participants were mostly female (85.9%), mostly White/Caucasian (72.9%), and most already had a bachelor\'s degree (50%) or higher (9.6%). Individuals who were White, non-Hispanic/Latinx, or had master\'s level or doctoral level mental health training were more likely to have higher SBIRT scores. Those with the highest levels of self-efficacy had the lowest change scores on the knowledge test. Overall, there was an almost threefold increase in SBIRT knowledge posttraining, indicating the viability of this training format, which is similar to findings from studies of in-person trainings of SBIRT which also found increases in SBIRT knowledge.Conclusion: Recommendations based on the results are provided to encourage improved student outcomes from this type of e-learning.

OBJECTIVE: To implement the 5Ps Screen for Alcohol/Substance Use tool and the screening, brief intervention, and referral to treatment (SBIRT) process into clinical practice to determine if enhanced training would improve perinatal providers\' adherence to universal screening.
METHODS: A quality improvement project using a pre- and postintervention design.
METHODS: Three community-based, outpatient obstetrics and gynecology clinics in southeastern Massachusetts. The local problem identified was that no validated screening tool was being used for universal screening of substance use in pregnancy.
METHODS: Training consisted of two phases that reviewed the SBIRT process, the 5Ps screening tool, brief intervention conversations, and the process for referral to treatment. Pre- and postimplementation screening rates were compared and analyzed using descriptive statistics and chi-square tests of independence.
RESULTS: Preimplementation screening rates were 14.4%. Screening rates measured 1 month after implementation were 44.6% (p < .001). Universal screening was not achieved.
CONCLUSIONS: Short-term improvement in screening for perinatal substance use was observed. Whether these results are sustainable beyond the project time frame is unknown. Future work should examine longer-term outcomes and continued barriers to universal uptake of the screening protocol.

Health inequities related to alcohol use exist for transgender individuals. While the Thailand Ministry of Public Health recently published a clinical guideline to implement a Screening, Brief Intervention and Referral to Treatment (SBIRT) in primary care, there has been no study regarding transgender women\'s (TGW) alcohol use and the acceptability of implementing SBIRT in a Thai context, a gap this study aimed to fill.
A mixed-method approach was used. In the first phase, TGW service users and health-care providers (HCPs) completed a survey on the acceptability of prospective implementation of SBIRT. TGW service users completed the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C). In the second phase, TGW service users, HCPs, clinic administrators and national-level alcohol, HIV and transgender health policymakers participated in in-depth qualitative interviews.
The Tangerine Clinic, a transgender-led sexual health clinic in Bangkok, Thailand.
In the first phase, TGW service users (n = 100) and HCP (n = 8) were surveyed. In the second phase, 22 stakeholders (n = 10 TGW service users; n = 8 HCP; n = 1 clinic administrator; n = 3 policymakers) were interviewed.
Simple proportions were calculated for each survey item. Differences in acceptability by various demographic factors were calculated using univariate analysis. The qualitative data were coded using thematic analysis and a deductive approach. The results were mapped to the Consolidated Framework for Implementation Research domains and constructs. The quantitative and qualitative results were triangulated to expand understanding.
Fifty per cent of the TGW participants exhibited problematic drinking levels (AUDIT-C ≥ 4). Implementing SBIRT was highly acceptable, as more than 95% of participants reported agreeing or completely agreeing to receive SBIRT for alcohol use. Barriers, such as complexity, time constraint and lack of knowledge and skills, were anticipated. Adaptability, such as tailoring the content of brief intervention to suit TGW health needs and SBIRT to fit with existing clinic procedures, might facilitate successful implementation.
Screening, Brief Intervention and Referral to Treatment (SBIRT) for alcohol use has the potential to be successfully implemented in transgender-led sexual health clinic settings, with some adaptations to overcome anticipated barriers.

OBJECTIVE: Perinatal substance use is a growing concern across the United States. Universal screening, brief intervention, and referral to treatment (SBIRT) is one systems-level approach to addressing perinatal substance use. The objective of this study is to assess early efforts to implement SBIRT in an outpatient obstetric clinic.
METHODS: The research team implemented universal screening with the 5 P\'s screening tool. Providers then engaged patients in a brief intervention and referred to a care manager who then worked with patients via tele-health to connect patients with needed services. Feasibility was measured through the collection of aggregate data describing frequency of universal screening and referral to treatment. The implementation team met bi-weekly to reflect on implementation barriers and facilitators.
RESULTS: In the first year of implementation, 48.5% of patients receiving care in the clinic completed the 5 P\'s screener at least once during the perinatal period. Screening occurred in a little over a quarter (26.5%) of eligible visits. Of the 463 patients that completed the 5 P\'s at least once during the perinatal period, 195 (42%) unique patients screened positive (answered yes to at least one question).
CONCLUSIONS: Early implementation efforts suggest this approach is feasible in this obstetric setting. Similar implementation studies should consider implementing universal screening for substance use and perinatal mood and anxiety disorders simultaneously; guide efforts using an implementation framework; invest resources in more intensive training and ongoing coaching for providers; and adopt strategies to track frequency and fidelity of brief intervention.