**University of Missouri Health Care**

**Program Description**

The SBIRT training program at University of Missouri Health Care (UMHC) aims to develop and use a new curriculum to train residents and many other learners in the knowledge and skills they need to detect, assess, and manage alcohol and drug problems.

The purpose of our program is to:

· Deliver SBIRT training to all 184 residents during each year of their training in six major clinical departments.

· In subsequent years, to provide additional, more specialty-specific training to residents who have been through the first-year curriculum.

· To monitor residents’ implementation of SBIRT in their work with their own patients.

· To deliver the training to all third-year medical students, to students in the School of Nursing, and to students in the School of Social Work.

· To provide training to community clinicians. 

**Program Model**

The curriculum’s didactic training consists of four online modules that address:

1. The background and epidemiology of substance use problems

2. Tools for screening and assessment

3. The stages of change model, core concepts of motivational interviewing, and key motivational interviewing techniques

4. The key steps, tools, and techniques to provide an effective brief intervention.

The modules are now available on the University’s internal Blackboard site, but will soon (by February 2011) be freely available on the web. This content can also be delivered in part or entirely in lectures. Each of the key principles and techniques of motivational interviewing is illustrated by video examples of good and bad technique. These will be integrated into the modules on the web. This didactic content is followed by lecture/discussion with role playing.Residents and other learners then work with simulated patients in the clinical settings of the Simulation Center. Each interviews a patient, those encounters are digitally recorded, and the small group then reviews examples from each person’s recording, providing one another feedback.

The final part of the curriculum is monitoring implementation of SBIRT into the resident’s clinical work by periodic anonymous surveys of patients as they leave the inpatient or outpatient unit and by residents’ self-reports of times they have applied SBIRT knowledge and skills in a patient encounter. Currently, all residents in Ob-Gyn, Child Health, Family Medicine, Psychiatry, Internal Medicine, and Surgery have gone through this curriculum or are scheduled to do so by June 2011. Beginning in July 2011, we will deliver this curriculum to incoming R1s and implement new training in the Simulation Center with residents who have been through the first-year curriculum. Training in second and subsequent years will be focused on the types of patients and clinical encounters seen by residents in each department, such as addressing substance use in adolescents, pre-op brief intervention for smoking cessation, pharmacotherapy of dependence, safe prescribing of controlled medications, and physician impairment.

In addition to all residents in each of 6 clinical departments, the training is being delivered to all third-year medical students as part of their Psychiatry Clerkship, undergraduate students in the School of Nursing, and beginning January 2011 to students in the School of Social Work. Faculty physicians are strongly encouraged to learn these skills, and the training is being taken to community clinicians beginning in December 2010. In collaboration with the SAMHSA SBIRT grant to the State of Missouri, we are placing health coaches in healthcare settings across the institution (Emergency Department, Family Medicine clinic, Student Health Center, inpatient units in Psychiatry, and inpatient and outpatient sites in Internal Medicine).

**Service Features**

The project has strong faculty support from all six clinical departments in the School of Medicine, from faculty in the School of Nursing and the School of Social Work, and from the Vice Chancellor for Health Sciences and the CEO of the University of Missouri Hospital and Clinics.

Evaluation of the project will include assessment of residents’ knowledge, attitudes, and skills at baseline and annually. Data will be gathered from

1. A questionnaire completed before training to assess knowledge and attitudes.

2. Observation of residents’ performance with simulated patients during training each year.

3. Anonymous patient exit questionnaires to measure how often and, from the patient’s perspective, how well the resident addresses alcohol and drug use and problems.

4. Residents’ self-reports of clinical encounters in which they applied SBIRT knowledge and skills in the care of patients.

In some departments (Internal Medicine, Family Medicine, and likely others) residents’ work with patients will be directly observed by faculty who will evaluate SBIRT performance. In conjunction with the IT staff at UMHC, we will build electronic clinical notes that include information about screening results, brief intervention delivered, and referral to treatment and/or follow up care so that these variables can be tracked.

All residents and all first- and third-year medical students will have encounters with simulated patients in the Simulation Center each year. Inpatient and outpatient work in Ob-Gyn and Child Health has moved to the newly refurbished Women’s and Children’s Hospital, an integral part of the academic health science center. Because it is several miles from the Simulation Center, we’ll take the Simulation Center staff, actors, and equipment to their clinics. 

With other funding, the University has purchased a remodeled RV that will allow us to take Simulation Center equipment and staff to clinicians throughout Missouri.

**Key Staff and Contact Information**

Program DirectorDaniel C. Vinson, MD, MSPH306C Health Sciences CenterDepartment of Family and Community MedicineSchool of MedicineColumbia, MO 65212(573) 882-3184Fax (573) 884-6172Email: VinsonD@health.missouri.edu

Program DirectorBruce Horwitz, PhDUniversity of Missouri Psychiatric Center, Room 310Department of PsychiatrySchool of MedicineColumbia, MO 65212 Phone (573) 882-8930Email: HorwitzB@health.missouri.edu

Program Evaluator and CoordinatorDebra Sprague, MAUniversity of Missouri Psychiatric Center, Room 309Department of PsychiatrySchool of MedicineColumbia, MO 65212Phone (573) 884-0373Fax (573) 884-1070Email: SpragueDJ@health.missouri.edu