Screening, brief intervention and referral to treatment (SBIRT): implementation barriers, facilitators and model migration
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Aims: To identify barriers and facilitators associated with initial implementation of a US alcohol and other substance use Screening, Brief Intervention, and Referral to Treatment (SBIRT) grant program, and to identify modifications in program design that addressed implementation challenges. Design: A mixed‐method approach used quantitative and qualitative data, including SBIRT provider ratings of implementation barriers and facilitators, staff interview responses and program documentation. Setting: Multiple sites within the first seven programs funded in a national demonstration program in the United States. Participants: One hundred and two SBIRT providers were surveyed; 221 SBIRT stakeholders and staff were interviewed. Measurements: Mean ratings of barriers and facilitators were calculated using provider survey responses. An inductive content analysis of interview responses identified factors perceived to support and challenge implementation; program modifications that occurred over time were recorded. Findings: Providers rated pre‐selected implementation facilitators higher than barriers. Content analysis of interview responses revealed six themes: committed leaders; intra‐ and inter‐organizational communication/collaboration; provider buy‐in and model acceptance; contextual factors; quality assurance; and grant requirements. Over time, programs tended to: adopt more efficient ‘pre‐screen’ item sets; screen for risk factors in addition to alcohol/substance use; use contracted specialists to deliver SBIRT services; conduct services in high‐volume emergency department and trauma center settings; and implement on‐site and telephonic treatment delivery. Conclusions: Screening, Brief Intervention and Referral to Treatment program implementation in the United States is facilitated by committed leadership and the use of substance use specialists, rather than medical generalists, to deliver services. Many implementation challenges can be addressed by an adequate start‐up phase focused on comprehensive education and training, and on the development of intra‐ and inter‐organizational communication and collaboration; opinion leader support; and practitioner and host site buy‐in.
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Acceptance of the contracted specialist approach was greater when SBIRT staff were well integrated into their host settings.
“Acceptance of the CS approach was enhanced when SBIRT staff members were well integrated into their host settings.”
From Screening, Brief Intervention and Referral to Treatment: implications of SAMHSA's SBIRT initiative for substance abuse policy and practice (2017) · cites this paper as [22]
All cohort 1 programs migrated toward contracted specialist (CS) models in order to increase screening rates and reduce the burden on medical staff.
“all cohort 1 programs migrated toward CS models to increase screening rates and reduce the burden on medical staff.”
From Screening, Brief Intervention and Referral to Treatment: implications of SAMHSA's SBIRT initiative for substance abuse policy and practice (2017) · cites this paper as [22]
Six domains of conditions that might help or hinder program operation were identified: committed leaders; intra- and inter-organizational communication/collaboration; provider buy-in and model acceptance; contextual factors; quality assurance; and grant requirements.
“Six domains in which conditions might help or hinder program operation were identified: committed leaders; intra-and inter-organizational communication/ collaboration; provider buy-in and model acceptance; contextual factors (e.g.patient/client populations); quality assurance (e.g.staff training, monitoring); and grant requirements (e.g.screening quotas, data collection mandates).”
From Screening, Brief Intervention and Referral to Treatment: implications of SAMHSA's SBIRT initiative for substance abuse policy and practice (2017) · cites this paper as [22]
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- Authors
- Vendetti, J., Gmyrek, A., Damon, D., Singh, M., McRee, B., & Del Boca, F.
- Affiliations
- UConn Health (US)
- JBS International (United States) (US)
- Department of Community Medicine and Health Care UConn Health, School of Medicine Farmington CT USA
- Corresponding author
- Vendetti, Janice
- Venue
- Addiction
- Publisher
- Wiley
- Published
- 2017-01-10
- Volume
- 112
- Issue
- S2
- Pages
- 23-33
- ISSN
- 0965-2140 (ISSN-L)
- 1360-0443
- OpenAlex
- W2573541319
- Cited by
- 135
- References
- 37
- Citations by year
- 2026: 6 · 2025: 9 · 2024: 19 · 2023: 9 · 2022: 17 · 2021: 24 · 2020: 16 · 2019: 16 · 2018: 6 · 2017: 12
- FWCI
- 22.16
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Addiction (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Health and Human Services
- Substance Abuse and Mental Health Services Administration
- Center for Substance Abuse Treatment
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Keywords
- SBIRT, implementation barriers and facilitators, model migration, alcohol screening, substance use screening, emergency department, trauma centers, leadership, quality assurance
- MeSH terms
- Attitude of Health Personnel, Emergency Service, Hospital, Humans, Mass Screening, Referral and Consultation, United States, Substance-Related Disorders, Qualitative Research, Motivational Interviewing
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