Decision Support to Enhance Prenatal Care Using the Screening, Brief Intervention, and Referral to Treatment Model

Kathie Records, PhD, FAAN; Shelly Hanko, PhD, FNP-BC


Journal for Nurse Practitioners. 2016;12(9):605-612. 

In This Article

Abstract and Introduction


Timely and adequate prenatal care and associated health screenings contribute to optimal health for the woman and her developing fetus. Prenatal screening is crucial for the nurse practitioner, who may be the only provider of care. This article provides the nurse practitioner with an adaptation of the Screening, Brief Intervention, and Referral to Treatment model with realistic standard-of-care screening tools, interpretation of scores, and referral resources for scores warranting intervention. Early differentiation of risk levels can help promote positive health outcomes for the woman and her baby.


Prenatal care for the woman and her developing fetus contributes to optimal health outcomes. Prenatal screening is critical because obstetric care providers: (a) have frequent contact with women during pregnancy and birth; (b) may be the only care provider the woman visits on a regular basis during her lifetime; and (c) are the vanguards for early identification of health deviations and prompt intervention to avoid negative sequelae.[1] Among care providers in clinical settings that implement prenatal screening as a standard practice, there is a lack of recognition of high screen scores or misattribution of high scores to the somatic and expected symptoms of pregnancy,[1] inadequate preparation for intervening, uncertainty regarding resources to recommend for patients, and inadequate community health resources.[2] The nurse practitioner (NP) often is the routine care provider until client abnormalities are seen or in between the less frequently occurring obstetrician visits. Over the previous decade, there has been a 30% increase in prenatal visits conducted by physician assistants or NPs,[3] highlighting the importance of a concise and evidence-based resource for health screening during pregnancy.

This article outlines a suggested protocol to inform clinical decision-making during prenatal screening for some of the common health deviations during pregnancy. An adaptation of the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model developed by the Substance Abuse and Mental Health Services Administration[4] is presented that includes universal screening to help identify the appropriate level of services needed based on the patient's risk level. SBIRT is a community- and evidence-based practice that began as an early intervention approach to identify individuals needing treatment prior to the point of needing specialized care or emergency treatment for substance use.[4] The Substance Abuse and Mental Health Services Administration website has a variety of resources to assist with screening and to train practitioners in use of the SBIRT model of practice.[4]

In general, patients who indicate little or no risky behavior and have a low screening score may not need an intervention, whereas those with moderate scores may be referred to brief intervention. Patients who score high may need either brief treatment or a further diagnostic assessment and more intensive, long-term specialty treatment. Expanding the SBIRT model from a focus solely on substance use to screening, intervention, and brief referral for major health deviations during pregnancy could provide an important evidence-based reference for NPs. Table 1 shows an application of the SBIRT model for prenatal care practitioners with suggested categories for low, moderate, and high risk, based on current evidence. The evidence-based recommendations in Table 1 are briefly reviewed in the following sections.