**University of Maryland, Baltimore**

**Program Description**

The purpose of the University of Maryland’s MD3 (**M**arylan**D****M.D**.s **M**aking a **D**ifference) program is to create an innovative and comprehensive medical residency training curriculum for Screening, Brief Intervention, Referral, and Treatment (SBIRT) for individuals who misuse, abuse or are dependent on substances including illegal drugs, prescription medications, alcohol and nicotine.  SBIRT training and procedures will be integrated into participating primary care residency programs of the University of Maryland Medical Center (UMMC) including Emergency Medicine, Family Medicine, Internal Medicine, Obstetrics-Gynecology, Pediatrics, and Psychiatry encompassing approximately 330 residents. Related fellowship programs (such as Child and Adolescent Psychiatry, Behavioral Pediatrics with approximately 35 fellows) and residents rotating through the Shock Trauma Center will also be trained in the first phase of the program.  

The University of Maryland Medical Center is located in west Baltimore.  Baltimore has a population of approximately 631,000 residents covering an area of 80 square miles.  About 53.4% of Baltimore residents are female.  Ethnically, Baltimore is 64.8% African American, 31.7% Caucasian, 2.4% Hispanic and 1.9% Asian.  The medical center is the primary hospital for the largely low-income residents in west Baltimore.  Because it also serves as a tertiary care hospital for various transplant services, oncology and the Shock Trauma Center, patients from all over the state as well as the surrounding states (Delaware, Virginia, West Virginia, and Pennsylvania) and Washington D.C. are also seen frequently at the hospital.

**Program Model**

The MD3 residency training curriculum will be motivational as well as educational in scope, include the best SBIRT practices already existent in the literature, and address current barriers to implementation and adherence.  We will address barriers including negative outcome expectancies, inadequate skills and self-efficacy, and lack of motivational enhancement strategies to overcome physician concerns and include facilitating factors of user friendly screening procedures, reporting systems integrated into intake and medical record systems, clear referral options, and effective transitioning to appropriate treatments to facilitate ease of adoption.  This curriculum will include didactic and practice components as well as the use of video and interactive technology, web-based training, and standardized patients for practice and evaluation.  In phase two of the program, curriculum and training will be disseminated to other primary care residency programs in the Baltimore-metropolitan area that include approximately 700 residents.  The goal is to establish the MD3 curriculum as an essential, integrated part of the each residency training program so that it will continue post funding.   

**Services Features**

An evaluation protocol will guide development, implementation, and dissemination throughout the entire period of the grant funding.  Outcome measures will include residents improvement in knowledge, attitude, skills, and behaviors related to screening, brief intervention and treatment.  

Evaluation of the SBIRT curriculum will be assessed, in part, by a self-report questionnaire that consists of items assessing knowledge and skills, attitudes, and behaviors surrounding substance use that will mirror what is presented in the core SBIRT curriculum.  We will use a self-report Knowledge, Attitudes and Behaviors (KAB) questionnaire that will be completed by the residents prior to initiating the SBIRT curriculum and the residents will be re-assessed post-training (i.e., on the final day of the rotation or within 2 weeks of completion of the curriculum).  

We will also use direct observation as a method of assessing each resident’s competency-level across the four substance use areas (tobacco, alcohol, prescription medications, and illicit substance). We plan to use a mixture of standardized and actual patients as well as the patient vignettes (written or taped) to assess each resident’s competency at implementing SBIRT.  We will assess chart reviews in the residency clinics to assess the level of fidelity for the implementation of the screening and brief intervention skills derived from the SBIRT curriculum.  We also will track how well the actual implementation of the curriculum matched the plan of the curriculum, by using an assessment that will be completed by each instructor at the end of training session that details all of the elements and activities completed during that training session.  

This team is directed by Dr. Christopher Welsh from the University of Maryland, School of Medicine (UMMC) and Dr. Carlo DiClemente from the Department of Psychology at UMBC who collaborated previously on an SBI intervention program. The team will include a board of residency directors, educators, trainers, and practitioners that includes multiple individuals who have been involved in curriculum development and implementation as well as SBIRT research at UMB.  

**Key Staff and Contact Information**

Program DirectorChristopher Welsh, M.D.University of Maryland School of MedicineDepartment of PsychiatryDivision of Alcohol & Drug AbuseRoom P-1-H-10 Box 34922 South Greene StreetBaltimore, Maryland 21201(Ph) 410-328-3716(Fax) 410-328-7919 (Email) cwelsh@psych.umaryland.edu

Program DirectorUniversity of Maryland, Baltimore CountyDepartment of Psychology1000 Hilltop CircleBaltimore, MD 21250(Ph) 410-455-2811(Fax) 410-455-1755(Email) diclemen@umbc.edu

Program EvaluatorJanine Delahanty, Ph.D.University of Maryland, Baltimore CountyDepartment of Psychology1000 Hilltop CircleBaltimore, MD 21250(Ph) 410-455-1482(Fax) 410-455-1755(Email) delahan1@umbc.edu

Program ManagerKatherine Earley, M.Ed. University of Maryland School of MedicineDepartment of Psychiatry110 S. Paca StreetBaltimore, MD 21201(Ph) 410-328-3672 (Fax) 410-328-1749(Email) kearley@psych.umaryland.edu