New Substance Abuse Prevention Method at Center of Rush Grant

Thursday, October 30, 2014

Rush University Medical Center was recently awarded a nearly $1 million grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) to better prepare its students and residents in identifying and treating patients at risk for drug and alcohol addiction.

The Screening Brief Intervention Referral for Treatment (SBIRT) grant will span three years and bring in $922,000 to fund the training and study of a technique that may allow health care workers to better help people who are dealing with substance abuse. More than 400 students in Rush University’s College of Nursing and medical residents in select programs will be trained as part of the grant, which is the only one of its kind among academic medical centers in Illinois.

“A lot of people in the health care field don’t know necessarily how to address this problem,” said Julie Worley, PhD, FNP, PMHNP, assistant professor in the College of Nursing and an assistant director on the grant. “This grant represents a whole different approach, and it gives trainees the skills and the tools to address the problem and to help their patients.”

For years doctors and nurses have used a top-down approach to persuade patients to stop alcohol and substance abuse — basically “lecturing,” said Niranjan Karnik, MD, PhD, associate professor and grant program director. That path has been found to be largely ineffective.

In contrast, the SBIRT grant will train Rush students and residents in “motivational interviewing” — a non-judgmental conversation with patients about their substance use that follows a screening. Doctors and nurses work with the patient to single out strategies for change, provide treatment or write a referral for a specialist if needed.

The grant work targets a larger “middle block” of patients — those who use drugs or alcohol but are not yet considered addicts — across a wide age range, Karnik said. These people would come into primary care clinics for other issues and receive the screening.

SBIRT training will feature in-class and online options, and students and residents will have access to an interactive learning system, with on-site clinical feedback from faculty for a portion of trainees. Faculty will also follow up with trainees after a year to see how they’re implementing the SBIRT model and evaluate its effectiveness.

The SBIRT funding is the first interprofessional grant Rush has received. All instruction will be done from a common curriculum, allowing for collaboration and consistent messaging across disciplines. From the College of Nursing, Direct Entry Master’s, Generalist Entry Master’s and Doctor of Nursing Practice students, which include nurse practitioners, will be among those trained, along with residents from the pediatrics, internal medicine and psychiatry programs.

This new effort builds on work from recent SBIRT-related funding at Rush and allied organizations, Karnik said. The Rush Department of Health and Aging had been part of a multi-site collaboration to pilot a specialized SBIRT method for older adults. And SBIRT grants given to Access Community Health Network and the Illinois Department of Human Services can provide Rush faculty with a willing and helpful knowledge base, he added.

Karnik and Worley are joined on the grant team by co-principal investigators Mark Pollack, MD, chairperson of the Department of Psychiatry at Rush; and Kathy Delaney, PhD, PMH-NP, a professor in the College of Nursing. Gail Basch, MD, a psychiatrist at Rush, is the grant’s assistant director for psychiatry.

Ultimately, Rush would like to screen all primary care patients at its hospitals with the SBIRT model, Karnik said. Currently only in-patient psychiatric patients get the screening.

Changes like these would be made to anticipate a shift in U.S. substance abuse care that’s already in its early stages, with the focus moving to more active prevention. The shift might also tie in with future federal requirements.

What shape that may take is still to be determined, but these Rush students and residents will be ready to bring their SBIRT training wherever they go, Karnik said.

“We really are introducing evidence-based best practices that are time-effective into our clinical settings,” he said, “and we’re enabling our trainees to then take these forward into other clinical settings.”