**Yale University**

**Program Description**

The goal of this project is to promote the adoption of SBIRT among all primary care specialty residents at Yale (Internal Medicine, Primary Care, Medicine-Pediatrics, Pediatrics, Obstetrics and Gynecology, Psychiatry and Emergency Medicine) to improve the health of patients with alcohol and drug use disorders. 

The primary practice site is Yale-New Haven Hospital located in New Haven Connecticut. New Haven ranks among the poorest cities in the United States. 

Yale-New Haven Hospital (YNHH): Adult Primary Care Center, West Haven VA Hospital (Internal Medicine), the Pediatric Primary Care Center, (Pediatrics), and the Womens Center (Obstetrics and Gynecology), Crisis Intervention Unit (CIU) (Psychiatry), Adult ED, and Pediatric ED, (Emergency Medicine). 

Our existing training program under investigation allows for the training of 254 residents over 18 months with the potential to impact 92,018 patients per year just in our hospital system alone. 

**Program Model**

We have expanded and adapted our SBIRT curriculum for alcohol and other drugs for residents and practitioners (nurses, physician associates) in the specialties of Medicine, Pediatrics, Med/Peds, Obstetrics and Gynecology, Emergency Medicine and Psychiatry. We have modified the microsystems in each respective specialty practice site to ensure long term adoption of SBIRT. Furthermore, we have incorporated effective communication and cultural competency in all aspects of SBIRT policies and procedures. 

Yale University ranks #1 in U.S. News and World Report in the Medical Specialty Rankings for Drug and Alcohol Abuse and members of the Core Faculty have all played significant roles in research and service related to substance abuse. 

The following screening tools are being introduced to our residents: NIAAA 3 quantity and frequency questions, CAGE, CAGE-AID, TWEAK, ASSIST, AUDIT, and CRAFFT. We are currently in the process of developing innovative and enduring instructional strategies, including a computerized "virtual coach", to ensure ongoing support and training for residents and other practitioners. The approach we are using to teach brief intervention is the Brief Negotiation Intervention (BNI) which is a manual-guided therapy designed to be feasible in the clinical environment. The purpose of the BNI is to assist patients in recognizing and changing their alcohol and drug use patterns, combining techniques based on motivational interviewing and a stage-model of change. The main goals are to decrease the subjects ambivalence about 1) reducing their alcohol use, 2) ceasing their drug use and/or 3) signing up for a formal drug treatment program. 

**Service Features**

Yale-New Haven Hospital (YNHH) is racially and ethnically diverse, with 43.5% white, 37.4% black and 21.4% Hispanic residents. We will evaluate our success in achieving the learner objectives with a pre-post trial of the SBIRT curriculum intervention. We will perform several assessments of residents at baseline, upon completion of the SBIRIT curriculum, and at 1 month and 3 years after training, to evaluate the durability of the effects. In addition we will train all attending physicians, APRNs, PAs and CNMs in to perform brief interventions. We will also add a selected group of nurses to participate in our training sessions as well as our assigned social workers. We plan to disseminate all teaching materials and tools to the larger community of practitioners in Connecticut. Each specialty team will also present the curriculum at their professional state chapters meetings. This will broaden our influence regionally. 

**Contact Info**

YALE UNIVERSITY464 Congress Ave. Suite 260New Haven, CT 06520 

Project DirectorGail D'Onofrio, MD, MS464 Congress Ave. Suite 260New Haven, CT 06520Phone: 203-785-4044Fax: 203-785-4580Email: gail.donofrio@yale.edu 

Project EvaluatorMichael Green, MD, MScPO BOX 208033New Haven, CT 06520Phone: 203-573-6510Email: michael.green@yale.edu