Healthier You: Optimizing Screening, Brief Interventions, and Referral to Treatment (SBIRT) in the Emergency Department
Optimizing SBIRT for Drug-Using Patients in an Inner-City Emergency Department
2 other identifiers
interventional
878
1 country
1
Brief Summary
Screening, brief interventions, and referral to treatment (SBIRT) for drug use/abuse offers opportunities for early detection, brief intervention/treatment, and substance use treatment referrals for patients in medical settings. Although SBIRT components, particularly screening and brief interventions, have been shown to be effective strategies for addressing alcohol misuse in primary care, data are limited on using all of the components of SBIRT for drug-using patients, particularly in the Emergency Department (ED). Further, because of the often chaotic environment of EDs, many logistical and practical impediments exist for the adoption of the entire SBIRT model in this setting.
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at P75+ for not_applicable
Started Feb 2011
Typical duration for not_applicable
1 active site
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
Click on a node to explore related trials.
Study Timeline
Key milestones and dates
First Submitted
Initial submission to the registry
April 20, 2010
CompletedFirst Posted
Study publicly available on registry
April 29, 2010
CompletedStudy Start
First participant enrolled
February 1, 2011
CompletedPrimary Completion
Last participant's last visit for primary outcome
March 1, 2014
CompletedStudy Completion
Last participant's last visit for all outcomes
March 1, 2014
CompletedApril 7, 2016
April 1, 2016
3.1 years
April 20, 2010
April 6, 2016
Conditions
Outcome Measures
Primary Outcomes (2)
drug use
Drug use is measured using the NIDA-Modified ASSIST (Alcohol, Smoking and Substance Involvement Screening Test).
change over time (3, 6 and 12 months post-baseline)
drug use - number of days used
change over time (3, 6 and 12 months post-baseline)
Secondary Outcomes (4)
HIV risk behaviors
change over time (3, 6 and 12 months post-baseline)
health related outcomes (physical health)
change over time (3, 6 and 12 months post-baseline)
health related outcomes (mental health)
change over time (3, 6 and 12 months post-baseline)
health related outcomes (mental health)
change over time (3, 6 and 12 months post-baseline)
Study Arms (6)
CBI in ED with AMET at 3 months
ACTIVE COMPARATORcomputer-delivered brief intervention (CBI) at baseline with adapted motivational enhancement therapy-AMET at 3 months
CBI in ED with EUC at 3 months
ACTIVE COMPARATORcomputer-delivered brief intervention (CBI) at baseline with enhanced usual care-EUC at 3 months
IBI in ED with AMET at 3 months
ACTIVE COMPARATORintervener-delivered brief intervention (IBI) at baseline with adapted motivational enhancement therapy-AMET at 3 months
IBI in ED with EUC at 3 months
ACTIVE COMPARATORintervener-delivered brief intervention (IBI) at baseline with enhanced usual care-EUC at 3 months
EUC in ED with AMET at 3 months
ACTIVE COMPARATORenhanced usual care (EUC) at baseline with adapted motivational enhancement therapy-AMET at 3 months
EUC in ED with EUC at 3 months
ACTIVE COMPARATORenhanced usual care (EUC) at baseline with EUC at 3 months
Interventions
The multimedia, interactive Computer BI (CBI) condition will be delivered using tablet computers. The content and format will be easily negotiated by participants. The proposed CBI condition will use actors with 'green screen' to deliver scripted therapist content that will be highly tailored to individual responses. 'Green screens' are standard recording formats that allow for inserting engaging background and other overlays onto recorded material. This program will be viewed on a touch screen tablet computer with audio delivered via headphones. The CBI will be designed in a therapist video-delivered interactive style, that provides tailoring options for reviewing patient goals, providing feedback regarding substance use patterns and consequences, completing a "decisional balance" exercise, and formulating a change plan. It requires active participation and is not a passive video that is merely viewed.
IBI is a 30-minute intervention session with a master's-level clinician. The interventions will include FRAMES (Miller \& Rollnick, 2002): personalized Feedback (regarding substance use, risk factors), emphasis on Responsibility for change, Advice, Menu of options, Empathic clinical behaviors, and support of Self-Efficacy regarding making changes. The interventions are designed to address the primary target behavior of drug use, and will include a tailored review of participants' goals/values, feedback regarding their present substance use patterns and consequences, developing a discrepancy between their substance use and ability to meet goals and values through a decisional balance exercise, and formulation of a "change plan" tailored for each participant. IBI will be highly individualized to participants' goals, values and substance use, and will will follow similar session outlines and length of delivery as the CBI sessions.
This session will have a similar general outline to the sessions conducted in the ED, including a review of participants' goals and values, and a review of their substance use and consequences, use of decisional balance exercises as indicated, and review and modification of their change plan. For the AMET intervention, the intervener (at least master's level) will conduct a single session (\~30-45 minutes) in the community (HMC ED or our community research office). The therapist will be able to tailor their approach to each individual's needs and motivational state.
The EUC group will receive brief advice to change their drug use, as well as a booklet including information on community support groups, location of substance use treatment centers, mental health services, suicide prevention hotlines, risk of injecting drugs including HIV and hepatitis and HIV prevention and testing information.
Eligibility Criteria
You may not qualify if:
- patients who do not understand English (less than 1% in our prior work) -
- prisoners
- patients classified by medical staff as "Level 1 trauma" (e.g., unconscious, intubated on respirators, in need of immediate lifesaving procedures such as surgery)
- patients deemed unable to provide informed consent as stated above (e.g., intoxication, mental incompetence)
- patients treated in the ED for suicide attempts or sexual assault
Contact the study team to confirm eligibility.
Sponsors & Collaborators
- University of Michiganlead
- National Institute on Drug Abuse (NIDA)collaborator
Study Sites (1)
Hurley Medical Center Emergency Department
Flint, Michigan, 48503, United States
Related Publications (1)
Drislane LE, Waller R, Martz ME, Bonar EE, Walton MA, Chermack ST, Blow FC. Therapist and computer-based brief interventions for drug use within a randomized controlled trial: effects on parallel trajectories of alcohol use, cannabis use and anxiety symptoms. Addiction. 2020 Jan;115(1):158-169. doi: 10.1111/add.14781. Epub 2019 Oct 24.
PMID: 31400240DERIVED
MeSH Terms
Conditions
Condition Hierarchy (Ancestors)
Study Officials
- PRINCIPAL INVESTIGATOR
Frederic C Blow, PhD
University of Michigan
Study Design
- Study Type
- interventional
- Phase
- not applicable
- Allocation
- RANDOMIZED
- Masking
- NONE
- Purpose
- HEALTH SERVICES RESEARCH
- Intervention Model
- FACTORIAL
- Sponsor Type
- OTHER
- Responsible Party
- PRINCIPAL INVESTIGATOR
- PI Title
- Principal Investigator
Study Record Dates
First Submitted
April 20, 2010
First Posted
April 29, 2010
Study Start
February 1, 2011
Primary Completion
March 1, 2014
Study Completion
March 1, 2014
Last Updated
April 7, 2016
Record last verified: 2016-04
Data Sharing
- IPD Sharing
- Will not share