**Georgia Department of Human Resources -**

**Division of Mental Health, Developmental Disabilities and Addictive Diseases**

**Program Description**

Georgia BASICS (Brief Assessment, Screening, Intervention Continuum of Care System) is part of the third cohort of SBIRT project grantees. The project will be implemented within two primary organizations, Grady Health System (GHS) and the Medical Center of Central Georgia (MCCG). The intent of the project is twofold. First, it will increase the proportion of persons receiving SBIRT services in the emergency department and other clinics affiliated with GHS and MCCG. Second, it will develop an expanded and trained workforce with SBIRT competencies.

SBIRT services will be implemented in the emergency departments of the state's two largest medical facilities: Grady Health System in Atlanta and the Medical Center of Central Georgia in Macon . In year 3, the project will expand to selected primary care sites at each hospital. GHS will expand to its Department of Obstetrics prenatal clinics. MCCG will expand to two outpatient clinics: Anderson Health Center and the Family Health Center . 

Unique State and Regional factors for Georgia is that it is a rapidly growing state with a very diverse population including large numbers of African Americans, and a rapidly growing immigrant population, particularly Latinos.

During the first two years of the project, the populations served will be all those reporting to the emergency departments at GHS and MCCG. As the public provider in Atlanta and Macon , respectively, GHS and MCCG serve a large number of racial/ethnic minorities as well as large numbers of indigent and uninsured patients.

**Program Model**

**Screeners**

Health Education Specialists are used to conduct the screening/assessment and perform brief interventions. Those filling this role are from a variety of backgrounds including Public Health, Social Work, Marriage and Family Therapy, Addictions Counseling, etc. All Health Education Specialists have at least a bachelor's degree, with most having master's degrees in their respective fields.

**Pre-screen**

The project will use a single question alcohol pre-screen and single question drug pre-screen. For alcohol, men will be asked: “How many times in the past 12 months have you had 5 or more drinks in a day?” Women will be asked: “How many times in the past 12 months have you had 4 or more drinks in a day?” Anyone responding 1 or higher will be considered positive. For drug use, all patients will be asked: “ In the last twelve months, did you smoke pot (marijuana), use another street drug, or use a prescription painkiller, stimulant, or sedative for a non-medical reason?” Patients answering yes to this question will be considered positive.

**Screening tool**

Adult patients screening positive on the pre-screen will be administered the ASSIST. Adolescent patients screening positive on the pre-screen will be administered the CRAFFT.

**Mental health screening**

The assessment instrument includes the GAIN-SS (Global Assessment of Individual Needs – Short Screen) an empirically validated brief mental health screening tool.

**Plan to track number of veterans screened (pre or full) and services (BI, BT, RT)**

A question has been inserted into the full screen, inquiring as to whether the respondent is a veteran. This will allow us to document services received by veterans who screen positive on the pre-screen. We are currently working with the administration at MCCG to get the question about veteran status inserted into the demographic information collected by nurses at triage so that we will be able to track number of veterans screened. Brief Intervention 

Depending on a patient's ASSIST or CRAFFT score, brief interventions will be performed by the Health Education Specialists. Specific cut points for performing brief interventions related to at-risk alcohol use are still being considered. For drug use, adult patients scoring between 3 and 19 on the ASSIST will receive a brief intervention.

**Brief Treatment methods**

Again, the score on the ASSIST or CRAFFT will determine which patients receive brief treatment. Adult patients scoring between 20 and 26 on the ASSIST for either alcohol or drug use will be referred to brief treatment. Brief treatment will be conducted by SBIRT project staff (a substance abuse specialist) at an office located near the emergency department of each organization and will consist of 5-6 treatment sessions.

**Referral to treatment**

Adult patients scoring 27 or higher for either alcohol or drug use will be referred to a formal treatment setting. In Atlanta , patients will be referred to the Fulton County Department of Mental Health, Developmental Disabilities, and Addictive Diseases. Patients in Macon will be referred to River Edge Behavioral Health Center . Both of these organizations are licensed programs designed to treat addiction. Formal contracts with each of these agencies have been put in place to provide some additional funding to help cover the costs associated with the anticipated increased demand for treatment.

**Medicaid/Medicare/Insurance reimbursement**

The state of Georgia 's Medicaid program does not currently reimburse for assessments and brief counseling related to alcohol and drug use. We do, however, intend to begin coding and billing for reimbursement of these services for patients covered by Medicare and private insurance.

**Service Features**

· **Evaluation approach**

Unlike many other SBIRT projects, we are collecting data in advance of implementing formal services. For the first three months of data collection, health educators are conducting a full assessment with patients who screen positive and then providing them with a list of addiction treatment resources in the area. Both GHS and MCCG will enroll 1000 patients in this baseline “phase”. In terms of project evaluation, these patients will serve as a control group in order to better evaluate the actual impact of providing SBIRT services. We anticipate that patients receiving the full SBIRT services including brief intervention, brief treatment or referral to treatment will show significantly higher declines in alcohol/drug consumption, lower health care utilization, improved mental health functioning, etc. than patients receiving assessments during the baseline “phase”.

· **Collaboration**

A senior representative of the Georgia Department of Community Health (State Medicaid Authority) will sit on the GA BASICS Policy Steering Committee. 

GA BASICS initiatives beyond those explicitly required in the SBIRT RFA include medical education activities with Emory University , Mercer University and Morehouse Schools of Medicine.

**Program Effectiveness**

**Screening targets**

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**Contact Information**

Stephen H. O'Neil, M.A., CDPProject Director – GA BASICSOnaje Salim (Principal Investigator) Director, Office of Addictive Diseases E-mail: omsalim@dhr.state.ga.us

2 Peachtree StreetAtlanta , GA 30303Phone: (404) 657-2331 Fax: (404) 657-2256