# SBIRT:  The North Carolina Model

The NC Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (DMHDDSAS) was awarded a five-year SAMHSA SBIRT cooperative agreement to fund the implementation of SBIRT in primary care practices in 2011.  The grant-funded project (NC SBIRT) currently implements SBIRT in six primary care clinics located within two networks of primary care practices affiliated with Community Care of North Carolina (CCNC) and two sites of a Federally-Qualified Health Center (Robeson Health Care).   NC SBIRT funds eight full-time Care Ambassadors and eight substance abuse professionals (some of who are dually-licensed mental health and substance abuse providers) hired through three provider agencies - Partnership for a Drug-Free North Carolina, Daymark, and Robeson Health Care - who are paired with each other in each site.   

In the NC SBIRT process, individuals who come to the practices for their annual visits complete a form that the clinic routinely hands out to its patients.  Embedded in the form is one question for alcohol  - in the past year  did you have 5 (for men,  4 for women) or more drinks  in one day  - and one for illegal drugs and prescription drugs for nonmedical reasons.  

On-site grant-funded staff members (either the Care Ambassador or the clinician) administer alcohol (AUDIT) and drug screening (DAST-10) tests to those who respond positively to the pre-screen questions.  Patients are given the results of the tests in all cases where possible and are informed about how these compare with those of the general population.   Screening for mental health also occurs through the administration of the PHQ9 to those whose screening results indicate the need for intervention or referrals.

The core of the NC model is the location of a substance abuse professional in each selected site to ensure the seamlessness of services.  NC SBIRT clinicians provide brief intervention and brief treatment on-site or refer patients to specialty clinics through the state’s Managed Care Organizations (where appropriate) for more intensive treatment based on the results of the AUDIT and/or DAST10.  They also facilitate admissions to specialty clinics and provide linkages to community resources.  NC SBIRT Care Ambassadors and clinicians receive training on SBIRT and motivational techniques through the grant.

NC SBIRT provides training to physicians and allied staff of primary care practices in non-grantee sites and members of faith communities as part of its sustainability plan.  Another crucial component of the sustainability plan is the integration of NC SBIRT in federally- or state-funded programs over which the grantee (DMHDDSAS) has control.  Gambling addiction providers affiliated with NC Problem Gambling have already received training on SBIRT and are now required to screen individuals who call the gambling helpline for alcohol and drug use.  NC SBIRT is currently collaborating with CCNC, Public Health, and the University of North Carolina at Chapel Hill on the integration of SBIRT into the DMHDDSAS Perinatal Program.  More information about NC SBIRT can be found on www.**sbirtnc**.org.

Contact information for NC SBIRT:  Maria E. Fernandez Project Manager:   (ging@nc.rr.com: (919) 618 1164); Flo Stein, PI and Co-Project Director (flo.stein@dhhs.nc.gov; (919) 744 4670); Sara McEwen (sara.mcewen@governorsinstitute.org;  (919) 990 9559).