Megan Brooks

October 31, 2014

Educating students of nursing and of social work on screening, brief intervention, and referral to treatment (SBIRT) for risky drinking provides a valuable skill to help patients lead healthier lives, researchers say.

"Up to 20% of Americans use alcohol or drugs at risky or harmful levels. They do not have a substance use disorder and need formal treatment, but probably do not know that their level of substance use can cause new or worsen existing health problems," Heather J. Gotham, PhD, of the University of Missouri–Kansas City School of Nursing and Health Studies, told Medscape Medical News.

"SBIRT has been shown to decrease alcohol use and increase health outcomes in patients with risky use. However, most health professions' students do not receive any or enough training and education on how to screen and intervene with patients who are using alcohol at risky levels or who use drugs. Our goal is to have baccalaureate and nurse practitioner students and masters of social work students feel comfortable and confident in addressing substance use with their patients," Dr Gotham said.

In September 2013, the University of Missouri–Kansas City School of Nursing and Health Studies received a $934,223, 3-year federal grant to embed SBIRT training into the curriculum for nursing and social work students. The curriculum involves didactic training in substance use disorders and SBIRT, as well as role playing with classmates and faculty.

"Thus far, we have trained over 200 students, as well as faculty, clinical preceptors and field instructors who work with students, and other healthcare professionals who work in the Kansas City metro area," Dr Gotham explained.

The research was presented here at the American Psychiatric Nurses Association (APNA) 28th Annual Conference in Indianapolis, Indiana.

Eye-opening

Surveys completed by some of the students show that the vast majority were satisfied or very satisfied with the overall quality of training and instruction they received in SBIRT and with the materials provided. Students' knowledge of SBIRT increased significantly from before training to after training (P < .01).

"We hope that nurses learn that screening and intervening is within their scope of practice, and that nurse educators and faculty gain some insight as to how SBIRT training can be embedded into their curricula," Dr Gotham said.

Erin Ellington, DNP, RN, PMHNP-BC, was involved in the training of the psychiatric mental health nurse practitioner students.

"At first, some of the students were skeptical to the need for this training because, as psych nurses, they already assess and address substance misuse with their patients," she said. "But as they were immersed in the training, they learned to approach the patient interaction with motivational interviewing, which is different from their previous experience."

When role playing, the students "quickly realized that they were still novice at this type of screening and intervention," Ellington noted. "Paying close attention to risky use rather than only harmful use was new to them. And encouraging harm reduction activities, rather than only full abstinence, was new to many of them. As the training continued, the students definitely grew in their confidence regarding SBIRT with their patient population. Many of them are using it already in their clinical preceptorships," she added.

"There is a lot of work going on across the country to help primary, specialty, and acute care settings to implement SBIRT," Dr Gotham told Medscape Medical News. "And there are a number of different models for how to implement SBIRT, including using a team approach, embedding the screening tools into the electronic health record, and using a range of staff to conduct the screening and brief intervention."

This research was supported by the Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. The authors have disclosed no relevant financial relationships.

American Psychiatric Nurses Association (APNA) 28th Annual Conference: Poster 4. Presented October 23, 2014.

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