**West Virginia Screening, Brief Intervention, Referral and Treatment Project ("WV SBIRT")**

**Background:**

West Virginia is the only state in the nation entirely located in federally designated Appalachia, a mountainous region in the eastern U.S. that has experienced problems of poverty, poor health, and low educational levels for several generations. Appalachian culture is distinctive, and as disadvantaged as the cultures of urban-ethnic ghettos. In the five years between 1999 and 2004, deaths resulting from drug overdose in West Virginia rose 550%.This was the largest increase of any state in the country.West Virginia also leads the nation in methadone-related deaths per capita, and has the fastest growing rate of methadone overdoses in the nation.

**Project Model:**

The West Virginia SBIRT Project is an integrated/collaborative approach between community-based behavioral health centers and rural community-based primary health care clinics, trauma units and school based health clinics. The target population is rural Appalachian men, women and children ages 12 and over who are patients at these sites. The intent of the program is to provide early intervention for substance misuse/abuse. WVSBIRT enhances the state’s current system of care by increasing access to interventions for at-risk individuals and prevention of substance use disorders.  Patients are screened as part of the intake process and those with positive screens receive culturally appropriate, evidenced-based brief interventions or brief treatments by WVSBIRT clinicians.  Those needing more intensive/specialized treatment are referred to a community behavioral health center.  It has been demonstrated that interventions that are developed with consideration for Appalachian culture, values, language, and behaviors have been most successful. Since the target population is 100% Appalachian, by design, WVSBIRT specifically addresses these Appalachian cultural issues, while also utilizing the evidenced based SBIRT model. Additionally, there is a significant amount of research demonstrating that providing screening, brief intervention or treatment services results in positive outcomes.

A Policy Steering Advisory Committee with key stakeholders has been formed to provide strategic direction for policy changes at the state level and to integrate WVSBIRT into the existing system of care so that screenings/interventions for individuals will be available throughout the state after the initial five years of grant funding. 

Partnering sites prescreen all patients ages 12 to18 with the CRAFFT and patients ages 18 and over with the Adult Health History Questionnaire (AHHQ). If a positive screen is obtained, then the patient is immediately referred to the on-site WVSBIRT behavioral health clinician who further screens the patient with the ASSIST.  Once the ASSIST is scored, then a determination is made as to whether the patient receives brief intervention, brief treatment or is referred to the WVSBIRT behavioral health clinician located at the partnering behavioral health center site. Patients may also be screened with the PHQ-9 for depression.**Medicaid/Medicare/Insurance reimbursement is at issue for sustainability.**The greatest challenges for Screening/Brief Intervention sustainability in West Virginia are: 1)  there is no Medicaid reimbursement at the state level for screening patients for substance misuse in community behavioral health centers or primary care clinics.  2) the goal of integrating behavioral health care within the medical setting and  3) the current reimbursement structure only allows a Licensed Psychologist or a Licensed Independent Social Worker (LICSW) to bill for mental health services in the primary care setting.**Brief Intervention**Brief Intervention methods include: 1) those treatment procedures designed for persons who are exhibiting some problems associated with alcohol or other drug use but that are not deemed serious enough to warrant treatment within a specialist setting; and 2) those persons at risk for, or diagnosed with a Substance Use Disorder. *WVSBIRT*behavioral health clinicians will use Motivational Interviewing and Stages of Change as a clinical framework and will provide time-limited strategies to promote reduced use in the case of nondependent/at-risk clients, and in the case of dependent clients, to facilitate referral to specialized treatment programs. The primary goal in all cases is to increase motivation for behavior change by relating substance misuse as part of overall healthcare.  **Brief Treatment**Brief Treatment methods include Cognitive Behavioral Therapy and/or Motivational Enhancement Therapy.  Brief treatment, a systematic, focused process that relies on assessment, client engagement, and rapid implementation of change strategies, will also occur at partnering****sites with the *WVSBIRT*behavioral health clinician.**Referral to Treatment**Referral to Treatment will be made to the *WVSBIRT*behavioral health clinician located at the partnering Behavioral Health Centers**.**Each of the partnering behavioral health centers has satellite offices in the counties near the medical sites. Behavioral health clinicians located at the behavioral health center sites will be available at these satellite sites to see clients referred for treatment. Clients may also be referred to other resources if the partnering agency is not able to provide the services needed. On-going follow-up will be conducted within the clinical setting.

**SERVICE FEATURES**

***Target number of persons served through WVSBIRT***

**Special Features**

WVSBIRT is a project based on true collaborations. The program is designed to reach the more rural population throughout West Virginia. The project is a unique partnership between collaborating community behavioral health centers and rural FQHC primary care clinics, trauma units and school based health sites.  WVSBIRT intends to provide early intervention for substance use as well as address the stigma of seeking treatment for substance use and mental health issues by integrating a behavioral health provider in each of these rural areas, thus directly addressing the skepticism of the Appalachian culture.In addition to the WVSBIRT collaboration between the behavioral health centers and the medical sites, collaborative efforts with other projects include working with the West Virginia Library Commission to obtain educational information on the subjects of alcohol and substance use and abuse which will be distributed to the patients at the partnering sites through the WVSBIRT personnel.

**Contact Information**

West Virginia Screening, Brief Intervention, Referral and TreatmentWV Department of Health and Human ResourcesBureau for Behavioral Health and Health FacilitiesDivision on Alcoholism and Drug Abuse350 Capitol Street, Room 350Charleston, WV 25305

James A. Matney, SBIRT Clinical DirectorPhone: 304-558-0352Cell:  304-389-3287Email:  James.A.Matney@WV.GOV