SBI in Healthcare Setting
What is SBI in a healthcare setting?
Screening and Brief Intervention (SBI) and Brief Motivational Intervention (BMI) in a healthcare setting are promising methods that may reduce rates of heavy alcohol use and alcohol-related harm on college campuses. It consists of a screening and brief intervention based on motivational interviewing (Miller, 1983) delivered in a general healthcare setting, typically by a physician (Fleming, 1999). These clinically based interventions include personalized assessment and direct feedback, norms clarification, contracting and goal setting, risk reduction strategies, behavioral-modification techniques, and motivational enhancement (Zgierska and Fleming, 2009; Larimer and Cronce, 2007). These interventions are based on cognitive behavioral therapy and general education strategies.
Researchers found it is best to conduct the SBI during the students visit to the physician/clinician rather than doing so “after the fact” so that the window of opportunity to have an impact is not lost. Outcomes are much better when physicians have a 1-2 minutes conversation in the moment. Student trust in their physicians makes it is easy to do a “soft transfer” of the student to the appropriate resources.
Why Student Health Services?
Students have identified student health center medical staff and health educators as the most believable source of information about student health issues (2007 National College Health Assessment) and are generally more open to discussing sensitive issues in the context of routine medical care when they are more focused on their health (Schaus, 2009).
Additionally, high patient volume at student health centers enhances the ability to access a large number of students efficiently (Ehrlich, 2006), intervening before their behaviors become problematic.
More than 40 randomized control trials in the past 30 years have evaluated the efficacy of Screening and Brief Interventions with risky drinkers and over 70 studies have tested the effectiveness of SBIs in a medical/health care setting. The cumulative evidence shows clinically significant effects on drinking behavior and related consequences, the consensus being that screening and brief interventions should be promoted in general health-care settings (Babor, et al. 2000).
Research studies by Flemming et al. in 2010 and Schaus et al. in 2009 evaluate in-depth Brief Motivational Interventions (BMI) that were lead by either a physician or health service provider. In the Schaus study students who screened positive for high-risk alcohol use met with university health services provider in the student health center for two 15-minute sessions. The health provider used the MI framework to establish rapport during the first session and delivered alcohol skills training components of BASICS during the second session. The students provided this intervention experiences significant reductions over time in drinking behavior outcomes, peak BAC, peak number of drinks in a setting, average number of drinks per week, and numbers of time drunk in a typical week.
The majority of student health centers do not provide routine alcohol screening. Common barriers include limited time, lack of training, and resources. Even though physician/clinicians often say they do not have time to conduct a SBI, if they incorporate a 1-2 minute conversation with students who screen positive, the intervention will actually save them time in the long run (repeat visits, ongoing health issues resulting from drinking, etc.). Once clinicians are trained at doing this for substance abuse, they are often able to use the same type of conversational behavioral change theory for other topics (asthma, obesity, etc.).
One study of medical personnel in a student health clinic (SHC) that administered SBI’s showed that 81% were supportive of SBI in a SHC with only 6% agreeing that patients participating in an SBI stay longer at the SHC (Earlich et al. 2006).
Babor, T.F. & Higgins-Biddle, J.C. (2000). Alcohol screening and brief intervention: dissemination strategies for medical practice and public health. Addiction 95(5), 677-686.
Earlich, P. et al. (2006). Screening and Brief Intervention for Alcohol Problems in a University Student Health Clinic. Journal of American College Health 54(5), 279-287.
Schaus, J.F., et al. (2009). Alcohol Screening and Brief Intervention in a College Student Health Center: A Randomized Control Trial. Journal of Studies on Alcohol and Drugs