Although the USPHSTF, SAMHSA, the CDC, and NIAAA have affirmed the central role that healthcare providers play in screening, brief intervention, and referral to treatment (SBIRT) for alcohol abuse, translation of these recommendations to clinical practice continues to be elusive. To address this problem, Polaris Health Directions (Small Business) and the University of Massachusetts Medical School (Research Institute) have partnered to develop the Remote Brief Intervention and Referral to Treatment service for alcohol (R-BIRT). The R-BIRT will be closely modeled after existing evidence-based SBIRT models but will use a telehealth delivery system. Like the SBIRT model preferred by most clinicians, it will use a team approach consisting of a healthcare provider and a dedicated interventionist. However, unlike traditional models, the healthcare provider will call the toll-free R-BIRT line to engage a trained telecounselor rather than an in-person interventionist. Once the warm handoff is made, the healthcare provider will be free to continue his or her routine clinical duties, while the telecounselor will use specially designed enabling software to complete a brief motivational interview with the patient. When appropriate, the counseling will extend to a booster session 2 weeks after the initial contact. If the individual is clinically appropriate for referral, he or she will choose from a printed, tailored referral list (default), a faxed referral, or direct "patch in" to a treatment facility matched to the individual using an algorithm developed during previously funded efforts (R42DA032739). Summary reports will be automatically generated - one sent back to the referring healthcare provider and one to the patient. Finally, because self-help is a hallmark of modern recovery but it is often overwhelming to find trustworthy resources on the Internet, the individual will be given secure access to a personally tailored list of publically available e- and m-health programs targeting alcohol use that will have been systematically evaluated and organized. In Phase I, we will develop all of the components necessary for Polaris to create the R-BIRT service delivery model de novo, including the enabling software, manuals, and trainings.
The Aims are: (1) Design the R-BIRT service model, including writing the technical specifications for the software, the necessary manuals, and training materials;(2) Create and test the alpha prototype in the "laboratory;" and (3) Field test and refine the R-BIRT, including iterative testing and refinement with risky alcohol users recruited from the UMass emergency department until the R-BIRT meets our target criteria (n~30). Innovations include (1) accessibility across diverse medical settings with the same service;(2) appropriateness for individuals with varying severity;and, (3) expanded access to post-visit resources, including a booster session and a web portal that provides a clearinghouse of professionally vetted e- and m-health programs matched to the individual's needs. The R- BIRT's commercialization potential is strong. It will provide efficient, evidence-based alcohol SBIRT at a fraction of the cost of in-person models in an era of healthcare reform that requires such cost-effectiveness.
The Remote Brief Intervention and Referral to Treatment (R-BIRT) for alcohol is an innovative telehealth service model with potential to improve public health through evidence-based counseling and linking patients who abuse alcohol with professional and self-help treatment. The service model is being studied in the emergency department (ED) setting to demonstrate its utility in a medical setting with a very high prevalence of substance abuse;however, the model is relevant and will be accessible to a broad array of healthcare settings, including primary care practices. The traditional paradigm that relies upon training healthcare providers or on- site interventionists to perform screening, brief intervention, and referral to treatment (SBIRT) has proven unsustainable in most clinical settings. Our new model challenges this paradigm and offers the promise of not only clinical efficacy but increased cost effectiveness as well.