**University of Texas Health Science Center at San Antonio**

**Program Description**

The overall purpose of Project SBIRT-South Texas Area Residency Training (S-START) is to expertly train a cadre of resident physicians, many of whom will continue to practice in the South Texas region, in SBIRT techniques to detect and manage patients with or at risk for substance use disorders. Unique factors of the program include Project S-START which spans across multiple departments and locations throughout the five years of the program such as: Pediatrics, Family and Community Medicine, General Medicine, Ob-Gyn, Adult Psychiatry, Child Psychiatry, and McAllen Family Medicine. Populations impacted by the residency program and clinics are primarily Hispanic, bilingual, low-income adults and adolescents in the South Texas Area. Main locations entail the University of Texas Health Science Center at San Antonio & McAllen Family Medicine in McAllen & Brooke Army Medical Center Adolescent Medicine in San Antonio. Training targets for the 5 year life of the program include the total residents to be trained: 539 and the Number of Residents trained per Department for the five years of the program: Pediatrics - 107; Family and Community Medicine - 84; General Medicine - 163; Ob-Gyn - 41; Adult Psychiatry - 105; Child Psychiatry - 15; McAllen Family Medicine - 24. 

**Program Model**

The essential model of Medical residency training is in outpatient clinics, hospitals, and teaching conference settings. Augmented with independent study Blackboard modules. The philosophy, methods, and techniques for teaching and module development include open access of training materials convenient to the resident schedule, goal and objective-based independent study modules with small group discussion, role play, reflection, and other active learning strategies, updating outpatient health record format to include SBIRT cues and reinforce on-the-job learning, and blackboard modules. The unique program focus on curriculum development/dissemination will incorporate S-START Website with the area Substance Abuse Resource Directory, FCM include South Texas sites and dissemination through state CME venues. 

The Type of screening tools and methodologies proposed entail the HEADS format interview training, CRAFFT with 3 question pre-screen, CAGE-AID, TACE, and ASSIST for adult patients, and an algorithm for patient care ranging from anticipatory guidance to acute hospital admission, including cueing for giving praise and encouragement, brief advice, motivational enhancement, and acute care and detoxification. This highlights the unique and innovative training approaches incorporating ancillary modules on Blackboard, the S-START Website with the area Substance Abuse Resource Directory, updating outpatient health record format to include SBIRT cues and reinforce on-the-job learning. 

Approaches to training on Brief Intervention, Brief Therapy and Referral to Treatment include teaching Motivational Interviewing strategies, awareness of local resources; and how to access/build relationships, an algorithm for patient care ranging from anticipatory guidance to acute hospital admission, including cueing for giving praise and encouragement, brief advice, motivational enhancement, and acute care and detoxification. 

**Service Features**

The unique specialties or patient groups targeted for attention address Pediatric and Family Medicine as the initial target patient populations. Most Pediatric patients have Medicaid coverage or CHIP. Most adult patients have county-subsidized coverage (CareLink). Predominantly Hispanic. Less than 10% African American. The evaluation focus, methods and expected outcomes examine Substance abuse knowledge, attitude and skills; knowledge pretest, baseline attitudes survey; 12, 24, and 36 month follow-up of knowledge and attitudes; medical chart reviews show skills used and documentation, with expected outcomes of improved knowledge and attitudes and an increase in documentation of SBIRT activities in health records. 

Project Intentions to expand efforts outside original scope include a plan to investigate feasibility of including Nurse/NP/PA trainees with Trauma service or other services interested. To reinforce training, the project will plan to coordinate curriculum with local military base Adolescent Clinic currently serving as one of the adolescent medicine training sites for our house staff. Collaborations and dissemination with non-program organizations entail presentations planned with FCM at TexMed 2009, the annual TMA conference attended by many Family and Community Medicine practitioners as well as practicing pediatricians; Texas Pediatric Society annual meeting. Concepts pertaining to final results, products or programs to be created include the S-START Website & Updating outpatient health record format to include SBIRT cues. 

**Contact Info**

University of Texas Health Science Center at San AntonioSBIRT - South Texas Area Residency Training Program (S-START)7703 Floyd Curl Dr.San Antonio, TX 

Project DirectorJanet Williams, MDDepartment of PediatricsOffice: (210) 562-5344Fax: (210) 562-5319Email: jawilliams@uthscsa.edu 

Co-Project DirectorSandra Burge, PhDDepartment of Family & Community MedicineOffice: (210) 358-3914Fax: (210) 223-6940Email: burge@uthscsa.edu 

Project EvaluatorNancy Amodei, PhDDepartment of Community PediatricsOffice: (210) 567-7424Fax: (210) 567-7443Email: amodei@uthscsa.edu