**Indiana University**

**Program Description**

The Indiana University School of Medicine (IUSM) is integrating SBIRT into Indiana’s health care system to improve the health of the large number of adolescents and adults at risk of substance abuse disorders. Our primary goal is to train physicians to provide SBIRT services and to promote systemic change in residency programs by integrating SBIRT into the curriculum on a long-term basis. We are also developing exportable models of how to integrate SBIRT services into comprehensive outpatient clinic settings by involving allied health professionals and utilizing a variety of instruments using information technology as well as conventional tools.

A key objective is to develop physician buy-in to the importance and potential impact of SBIRT. That is, when they take up practice around the state they will see SBIRT as a priority and support practices by allied health personnel. By incorporating SBIRT into the residency continuity clinics, we are increasing access to interventions for both the residents’ and their attending physicians’ patients and the availability of brief interventions in the clinics. As more primary care physicians are trained in Indianapolis and around the state, additional access to intervention will be achieved. In lower risk areas, SBIRT is likely to have a greater role in prevention of harmful use and underage drinking.

The Indiana University School of Medicine is part of the Indiana University-Purdue University Indianapolis (IUPUI) campus in Indianapolis, Indiana. It is Indiana's only medical school. First- and second-year students attend classes at either the main Indianapolis campus (approximately half of the class) or one of eight regional centers at college campuses throughout the state: Bloomington, Muncie, Fort Wayne, South Bend, Terre Haute, Evansville, West Lafayette, and Gary. Third- and fourth-year students spend the last two years of medical school at the IUPUI campus, although we are expanding clinical training to other Centers of Medical Education noted above. 

Wishard Memorial Hospital and Health Services, located in Indianapolis, is operated by the Health and Hospital Corporation of Marion County, a Municipal Corporation of the State of Indiana. Wishard's medical staff is provided exclusively by faculty of the School of Medicine. Wishard is the primary hospital for a large portion of the low-income residents in Indianapolis. The main hospital campus includes the Myers Building (Intensive Care, Labor and Delivery, OB/GYN, Surgery, and General Medicine Wards) as well as other buildings housing the Level I Trauma Center, Level I Burn Unit, Psychiatric Care, Prisoner Care, Outpatient Surgery, Therapy, and Long Term Care. Wishard also operates numerous clinics across Indianapolis and Marion County.

**Program Model**

SBIRT at the Indiana University School of Medicine is bringing SBIRT to the IU medical community through a multi-pronged approach that includes integration with patient records systems and ongoing training and support of residents. The program model is broken down in Courses One, Two, and Three. Course one includes both didactic and practice segments. Web-based training and Motivational Interviewing provide the core of Course One, and upon completion, medical residents are overseen by their clinic preceptors. Web-based instruction includes sections on complications of social importance to reinforce behavior change of patients; screening tools and an algorithm for assessing a clinical practice for selection of the most appropriate tool; and brief intervention procedures, evidence of their effectiveness, brief treatment, indications for referral and resources for linking medical providers to addiction. Motivational Interviewing training consists of a full- day training with two experienced Motivational Interviewing instructors. At the full-day training, medical residents are first introduced to the SBIRT screening tool and are trained on how to interact with their patients using Motivational Interviewing techniques for successful flow through the SBIRT model. 

Courses two and three are still in development and are slated to be implemented in spring 2011 and spring 2012 respectively. 

**Service Features**

The SBIRT@IUSM project involves a consortium of several residency programs in the IUSM, including the Departments of Medicine, Emergency Medicine, Family Medicine, Pediatrics, and Obstetrics and Gynecology, led by the Department of Medicine chief Dr. David Crabb. The program is supported by three collaborating substance abuse treatment groups, including: the Indiana Prevention Resource Center who will provide expertise in optimizing SBIRT application by medical providers to different populations; Midtown Community Mental Health Center who will train faculty and residents in motivational interviewing and link referrals to substance abuse treatment providers; and Drug Free Marion County, who will serve as advisors to the practical application of SBIRT and facilitate collaborations with the University to the greater Indianapolis substance abuse treatment community. The Regenstrief Institute, an internationally recognized informatics and healthcare research organization, will set up physician reminders for screening and archive the results of screening in the electronic medical record. During the five years of the project we expect to involve >300 medicine and medicine-pediatric residents, and > 300 residents from other specialties and their associated faculty in implementing SBIRT, benefitting thousands of patients–who are predominantly female (60%) from low-income families of diverse culture and ethnicity.

The ultimate goal is to have every resident trained in Indiana in medicine, medicine-pediatrics, pediatrics, family medicine, emergency medicine and OB-GYN to provide SBIRT as part of their practice.

**Key Staff and Contact Information:**

Website: http://www.iusbirt.org

Principal Investigator David Crabb, M.D.Indiana University School of MedicineDepartment of MedicineEmerson Hall, Room 317545 N. Barnhill DriveIndianapolis, IN 46202 Phone: (317) 274-8438Email: dcrabb@iupui.edu

Program CoordinatorJoseph Bartholomew, M.S.W.Midtown Community Mental Health CenterWishard Health Services1001 W. Tenth StreetWest Building – M200 – 1st FloorIndianapolis, IN 46202Phone: (317) 630-6210Email: joseph.bartholomew@wishard.edu

Program EvaluatorRuth Gassman, Ph.D.Indiana UniversityIndiana Prevention Resource Center501 N. Morton Street, Suite 110Bloomington, IN 47404Phone: (812) 855-1237Email: rgassman@indiana.edu