**Mercer University**

**Program Description**

Though most people who misuse alcohol and drugs are unlikely to seek specialty treatment, most are seen in primary care medical settings. Screening, brief intervention and referral to treatment (SBIRT) has been shown to be effective in reducing substance misuse, however most physicians have not been trained in SBIRT. The Southeast Consortium for Substance Abuse Training (SECSAT) is a multisite, multistate SBIRT initiative which is addressing this need by creating model SBIRT training programs in four family medicine and internal medicine residency programs in the southeast—historically an underserved region with a large percentage of Medicare, Medicaid and medically uninsured patients—in the states of Georgia, North Carolina and South Carolina. 

Faculty in Mercer University School of Medicine’s Family Medicine residency program, building on experience gained in the NIH-funded Georgia-Texas “Improving Brief Intervention” Project, are working with faculty from Mercer’s Internal Medicine Residency Program, Wake Forest University’s Internal Medicine Residency Program (Winston-Salem, NC), and AnMed Health Family Medicine Residency Program (Anderson, SC) to create a comprehensive skills-based clinical curriculum with web-based modular components covering 13 core SBIRT competencies and an implementation guide for creating a clinic SBIRT system.

Multi-disciplinary teams from all residency clinics are receiving faculty development training, form implementation committees to implement universal screening in their residency clinics, and conduct quarterly resident training seminars for 126 residents each year. Mercer faculty is providing on-site support for SBIRT implementation and is overseeing on-site quality improvement. Efforts to promote sustainability of SBIRT training will include coordination with residency directors, maximizing and tracking reimbursement, and working with primary care policy agencies to make SBIRT training a requirement. Residents will receive training in how to implement SBIRT in their future practices. 

In Years four and five, SECSAT will disseminate SBIRT training as participating residencies mentor four new residency programs, training 54 additional residents. SBIRT workshops will be offered at statewide meetings of family physicians and internists in all 3 states, and faculty will offer on-site facilitation for startup. A total of 294 residents will receive 558 resident-years of training.

**Program Model**

The SECSAT SBIRT curriculum is being developed using traditional design methods, based on existing substance abuse objectives and structured to link with family medicine’s core competencies. Steps in the design model include stating the learning needs based on an assessment of gaps in current curricula, determining the objectives, defining the content and organizational plan of the curriculum, describing the learning experiences to take place, and developing an evaluation plan and plans to solicit support for the curriculum. The structure resulted in a 12-module curriculum which can be integrated into the educational program of the typical three-year U.S. Family Medicine or Internal Medicine residency program.

SECSAT is utilizing interactive skills training for participants using activities such as role plays, standardized patient interviews, etc. For this reason, each year’s curriculum is centered around a 3-hour seminar that gives time for skills practice and active learner participation. Additionally, because work hour requirements have decreased attendance rates at traditional afternoon conference sessions, all conference sessions will be available on the internet. Resident completion rates of 80% will be required for all curriculum modules.

**Service Features**

SECSAT is implementing SBIRT curriculum at two Family Medicine and two Internal Medicine residencies in the southeast. The first year curriculum has been devoted to teaching SBIRT to residents for use with their patients with at-risk or possibly dependent alcohol use behaviors. Because of the increasing importance of prescription drug abuse the second-year 3-hour seminar will be devoted to this problem. The third year curriculum will allow individual residencies to focus on important drugs of abuse in their areas. This will include a focus on methamphetamine abuse, which is highly prevalent in central Georgia and surrounding rural areas. Clinic information systems will track numbers of interventions performed by residents, annual clinician questionnaires will measure changes in attitudes and behaviors, and focus groups will provide qualitative feedback. 

Long-term follow-up of resident graduates and feedback from residency directors will help guide the next generation of SBIRT residency training. SECSAT is offering training in Motivational Interviewing and Brief Treatment to personnel at community referral sources utilized by each residency program. In years four and five, four additional residency programs will be assisted in integrating SBIRT into their curriculum. Additionally, SBIRT trainings will be held at state practitioner meetings in Georgia, North Carolina and South Carolina and technical assistance will be provided to participants who wish to implement in their practices. 

**Evaluation**

Project evaluation includes data collection from three different sets of subjects: patients, residents and faculty, and clinic employees at individual implementation sites. 

1. Baseline Data Collection: Prior to the initial training at each site, chart reviews were conducted to establish baseline rates of screening and brief intervention for at-risk alcohol and drug use, diagnosis rates for alcohol or drug disorders, use of pharmacotherapy for substance use disorders and formal referral to treatment. 

2. Organizational Assessment: Organization level information regarding factors which might impact SBIRT implementation has been collected from a random sample of each clinic’s personnel using a standardized instrument. 

3. Clinician Questionnaire: All residents and faculty participating in the annual 3-hour training seminars are consented and surveyed immediately prior to training as well as annually following the final training of the year to measure residents’ attitudes toward, knowledge of, and confidence in providing SBIRT services to patients. Residents graduating from participating residency programs will be contacted six months post-graduation regarding implementation of SBIRT in their subsequent practice settings. 

4. Rates of Screening & Brief Intervention: Delivery of SBIRT services within each of the clinics is being tracked either manually or via electronic medical record (EMR). 

5. Measuring Resident Proficiency: Residents are being assessed for their proficiency in delivering brief interventions using the Motivational Interviewing (MI) style by direct observation of patient care activities or interviews with standardized patients. 

**Participating Residency Programs**

Mercer University School of Medicine Family Medicine ResidencyMacon, GAJ. Paul Seale, MD, PI and Site Coordinator

Mercer University School of Medicine Internal Medicine ResidencyMacon, GADavid Parish, MD, Site Coordinator

AnMed Health Family Medicine ResidencyAnderson, SCHunter Woodall, MD, Site Coordinator

Wake Forest Internal Medicine ResidencyWinston-Salem, NCDavid Miller, MD, Site Coordinator

**Key Staff and Contact Information**

The Southeastern Consortium for Substance Abuse Training (SECSAT)Mercer University School of Medicine, Macon, GAFamily Health Center3780 Eisenhower Parkway, Suite 3Macon, GA 31206478-633-5731478-633-5575 fax

J. Paul Seale, MD, Principle Investigator478-633-5910Seale.Paul@mccg.org20%FTE 

Aaron Johnson, PhD, Director of Evaluation478-633-5548Johnson.Aaron@mccg.org15% FTE

Sylvia Shellenberger, PhD, Director of Training478-633-5546Shellenberger.Sylvia@mccg.org15% FTE

Denice Crowe Clark, MFT, Project Coordinator478-633-5731Clark.Denice@mccg.org100% FTE