Training Health Sciences Students in Screening, Brief Intervention and Referral to Treatment (SBIRT) for Substance Use

Introduction. The impact of substance use on health is staggering, as more deaths, illness, and disabilities can be attributed to substance use than from any other preventable health condition. Training health professional students to screen, intervene and refer patients for substance use treatment can ultimately improve patient care and patient outcomes at a decreased healthcare cost (Triple Aim). The objective of this project is to train healthcare professional students to conduct substance use screening using evidence-based tools, and conduct brief interventions using principles of Motivational Interviewing to guide their patients toward behavior change.

Methods. Screening, Brief intervention and Referral to Treatment (SBIRT) training has been embedded into the curricula of the professional degree programs in the School of Pharmacy, the Department of Physical Therapy, the Physician Assistants training program and the Clinical Rehabilitation and Mental Health Counseling program, as well as in the School of Medicine’s Psychiatry clerkship and residency programs. Over the past 2 years 829 students have completed the training. Students complete 8 hours of online training using an evidence-based online curriculum, which includes a virtual patient simulation program to provide students opportunity to practice effective brief intervention skills. Additionally, 2 hours of didactic instruction, role plays, and standardized patient interactions are provided by trained faculty. Students are expected to complete at least 2 SBIRT interactions with actual patients in their clinical settings and conduct a self-appraisal of those interactions which are reviewed by faculty to assess student performance in the field. Students may opt to be included in the research component by completing a Survey of Attitudes and Perception (SAP) pre- and post-training. This survey assesses (1) their knowledge of substance use and SBIRT, (2) the frequency with which they use SBIRT principles within their care of patients, (3) their perceived competence in applying SBIRT skills, (4) their attitudes about patients who use alcohol, and (5) their attitudes about patients who use illicit drugs.

Results. Nearly 80% of the students (N=652) completed the pre and post-training SAP. There were significant knowledge gains across all disciplines (Mean difference =1.318, F=3.453, p<.004). The entire group showed significant increases in the frequency of use of SBIRT principles, except the use of evidence-based screening tools. Significant discipline-specific positive changes were also evidenced across most of the measures.

Conclusions. All training cohorts have demonstrated knowledge gains about substance use, reported more frequent use of SBIRT in their clinical settings, positive shifts in attitudes about working with patients with substance use problems, and improved perceived competence in discussing substance use with their patients. The value added to the students’ educational experience has been demonstrated and needs to be continued as an integral part of their professional training.