**Allegheny-Singer Research Institute**

**POSITive:***Professional and Organizational SBIRT Implementation with Training*

*April 24, 2014*

**Program Description**

The Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment (SAMHSA-CSAT) is funding the Allegheny-Singer Research Institute for three years to train medical professionals in screening, brief intervention and referral to treatment (SBIRT) knowledge and skills. The ***P****rofessional and **O**rganizational **S**BIRT **I**mplementation with **T**raining* (**POSITive**) program is an effort of the Allegheny Health Network (AHN), in collaboration with the University of Pittsburgh Program Evaluation and Research Unit (PERU), to train nearly three-thousand medical residents and medical, nursing, dental and pharmacy students over three years. Our medical professional trainees are currently in the Allegheny General Hospital Emergency Medicine (AGH-EM) residency program, Forbes Family Medicine residency program and Western Pennsylvania Hospital School of Nursing (WPHSON) in the vicinity of Pittsburgh, PA, and the Lake Erie College of Osteopathic Medicine (LECOM) campus at Seton Hill in Greensburg, PA and campuses in Erie, PA and Bradenton, FL. Graduates of these targeted programs will provide care to typical patients located in a variety of healthcare settings, from emergency departments and inpatient settings to community-based settings (such as PCP offices, long term care facilities, medical clinics and urgent care clinics) to community and hospital pharmacies and community dental practices. 

Our mission with this program is to effectively train medical professional trainees and faculty members on SBIRT so they can proficiently practice SBIRT in any clinical site in which they work. We envision that our trainees will promote and disseminate SBIRT practices throughout the Commonwealth’s healthcare community, especially within the AHN. We envision being a significant factor in infusing SBIRT into healthcare training programs and clinical practices within AHN to fulfill the Triple Aim and that our sites will become self-sufficient to sustain and reinforce SBIRT practices at grant’s end

**Program Model**

Our overarching goal is to: (1) train the identified medical residents, medical students, nursing students, dental students and pharmacy students using a state-of-the-art, innovative, evidence-based curriculum that can be individualized to the unique environment of each training site in  identified knowledge objectives and skill targets; (2) ensure that each trainee is assessed to be proficient in applying SBIRT skills; and (3) ensure each learner has the opportunity to adequately practice their SBIRT skills with a preceptor within at least one clinical practice site. 

Our training program is embedded within one healthcare system that is eager to implement SBIRT throughout. We expect that AHN will become a model system from which other systems can learn how to seamlessly apply SBIRT in a variety of settings. AHN is part of a vertically integrated healthcare setting that includes a large payer. This payer intends to support the application of integrated care within AHN (including SBIRT) and will provide funding to evaluate its impact on patient care quality and costs. The POSITive training program will help support the workforce necessary to evaluate AHN integrated care approaches and our program will also develop a large number of professional “champions” who can influence SBIRT application regionally, statewide and beyond. 

The addition of pharmacists and dentists to our SBIRT training program is key to addressing the issue of substance use disorders among patient populations. Pharmacists are increasingly working with physicians in interdisciplinary teams to address patient care and are becoming more involved in addressing overdose prevention. Dentists are becoming a preferred target for obtaining prescription opiates that are then illegally diverted. We intend to provide the most effective training possible to ensure that each trainee can demonstrate significant knowledge acquisition and proficiency in practicing relevant SBIRT skills.

**Special/Unique Features**

Our training program begins with bringing together senior leaders from each training program to form a multi-disciplinary steering committee, a Council of Directors (COD), to breach institutional barriers to implementation of the SBIRT curriculum, to develop plans to sustain and disseminate the SBIRT curriculum in professional training programs and to discuss and reinforce ways to ensure application of SBIRT in clinical settings. Next, and key to our program’s effectiveness and sustainability, is the identification and development of champions and a champion team within and across the training programs. These champions are essential in the development of training plans, curriculum modifications and SBIRT precepting capabilities that are responsive to the unique environment of each training program. The POSITive training staff assists the champions by providing the foundation of a multi-component, comprehensive SBIRT online curriculum (originating from a previous SAMHSA Medical Residency Training grant) and training expertise, such as proven knowledge and skill development exercises and supplemental material. The POSITive evaluation team has incorporated mechanisms and protocols for frequent and rapid feedback on the impact of training on trainee knowledge, skills, attitudes and perceptions of competency and confidence in addressing substance use with patients, and satisfaction with numerous facets of the POSITive program. Trainees are asked to participate in research that investigates changes in attitudes and perceptions prior to and following training. Trainees also complete training satisfaction assessments post training and, along with champions, participate in interviews and/or focus groups which explore the training experience more in-depth. Champions assess and report, centrally, on trainee SBIRT proficiency and we collect and summarize data on trainees’ SBIRT clinical application after training and following graduation. We also routinely collect quality improvement feedback regarding our program features, such as website and meeting satisfaction and recommendations for program improvement. Finally, the COD are able to monitor the program’s progress, lessons learned, assess corrective actions and endorse successes through a quarterly Scorecard that tracks progress towards our goals.

**Website URL:**https://www.positive.pitt.edu/ (Registration available upon request)

**Contact Information**