Social Workers as Workplace-Based Instructors of Alcohol and Drug Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Emergency Medicine Residents

ABSTRACT

Problem: Residency education is challenged by a shortage of personnel and time, particularly for teaching behavioral interventions such as screening, brief intervention, and referral to treatment (SBIRT) to reduce hazardous drinking and drug use. However, social workers may be well placed to teach SBIRT in clinical training settings. Intervention: We describe a curriculum with social workers as SBIRT trainers of emergency medicine (EM) residents during actual clinical shifts in an EM residency training program. The curriculum required 1 EM faculty member working with social workers and 1 additional hour of formal residency conference teaching time. Context: We implemented the curriculum at both a university tertiary care hospital emergency department and a county trauma center. We trained 8 social workers at both sites as SBIRT superusers to teach and assess EM resident SBIRT performance with actual patients. We measured the length and number of sessions to attain SBIRT competence, residents' satisfaction, and resident comments (coded by authors). Outcome: Five of the 8 social workers trained residents between June 2013 and May 2014, 31 EM residents trained to a level indicating SBIRT competence with 114 patients. Each patient interaction averaged 8.8 minutes and residents averaged 3.13 patients. Twenty-four (77%) residents gave ratings of 1.58 (SD = .58) for the quality of teaching, 2.33 (SD = .87) for recommending the training to a colleague, 1.38 (SD = .49) for superusers' knowledge, 1.88 (SD = .95) for usefulness of instruction, 1.54 (SD = .72) for workplace learning, and 1.58 (SD = .78) for valuing learning from social workers (on a scale of 1 [very satisfied/strongly agree] to 5 [very dissatisfied/strongly disagree]). Residents preferred learning SBIRT during the 1st and 2nd training years and in the workplace. Lessons Learned: Social work colleagues can be effective in teaching SBIRT to residents in the workplace, and our residents highly valued learning from social workers, who all had prior training in motivational interviewing. In the implementation of this curriculum, the clinical demands of residents must be taken into account when teaching occurs, and having multiple social worker instructors was instrumental.

KEYWORDS:

• residency education
• workplace-based learning
• interprofessional education
• substance abuse
• emergency medicine

Acknowledgments

We acknowledge Catherine Zhu of Stony Brook University, School of Medicine for her administrative support to this study.

Funding

Funding was provided by Substance Abuse and Mental Health Services Administration (Grant ID: 1U79TI020295-01).

Appendix

	NAME: □□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□
	DATE: :………..…□□□□□□
	Start time:__________________________ End time:______________________________
	SBIRT
	Adherence & Competence Checklist
	YES   NO
	STEP 1: SCREENING
1.	Screens patient for alcohol or drug use               □    □
	STEP 2: RAISE THE SUBJECT
2.	Asks the patient for permission to discuss alcohol/drug use       □    □
	STEP 3: PROVIDE FEEDBACK
3.	Reviews patient's drinking/drug use patterns             □    □
4.	Expresses concern about these patterns               □    □
5.	Informs patient of NIAAA guidelines/norms (may use cards if available)                             □    □
6.	Asks about a connection to ED visit                 □    □
7.	Reflects the patient's statement                  □    □
8.	Provides medical facts and information regarding a connection
	between the medical visit and drinking/drug use           □     □
	STEP 4: ENHANCE MOTIVATION
9.	Asks patient to identify readiness to change on readiness ruler/scale    □     □
10.	Asks why the patient chooses that number and not a lower one     □     □
	If the patient chooses 1 on the readiness ruler: See item #19
11.	Reflects/restates the patient's statements regarding change       □     □
12.	Elicits response (How does all this sound to you?)          □     □
	STEP 5: NEGOTIATE AND ADVISE
13.	Negotiates the goal (What would you like to do?)           □     □
14.	Gives advice if necessary                     □     □
15.	Summarizes (This is what I've heard you say…)            □     □
16.	Has patient fill out agreement card or referral agreement        □     □
17.	Suggests follow-up (social work/PCP/therapist)            □     □
18.	Thanks the patient for his/her time                 □    □
	Yes              No
	Ask Medical Practitioner, “What if the patient had chosen a 1 on the readiness ruler?”
19.	Did he/she ask patient, ‘What would make this a problem for you?”               □    □
20.	What is your overall entrustment that this provider can perform SBIRT (pick one)?
	This provider cannot yet be allowed to perform SBIRT                                    □ level 1
	This provider can perform SBIRT with full supervision                                    □ level 2
	This provider can perform SBIRT with supervision on demand                       □ level 3
	This provider can perform SBIRT unsupervised                                                □ level 4
	This provider can not only perform SBIRT unsupervised, but can
	be trusted to teach SBIRT independently                                                □ level 5
	Comments:______________________________________________________________________________
	________________________________________________________________________________________
	________________________________________________________________________________________
	Reviewer Name: _____________________________________Date:______________________