Focus on Research September 2014


John Muench, MD, MPH
John Muench, MD, MPH
Jim Winkle, MPH
Jim Winkle, MPH

By Jim Winkle, MPH
Project Director of the SBIRT Oregon Residency Initiative

John Muench, MD, MPH, Director of Behavioral Medicine at OHSU Family Medicine, has received a three-year award to increase the number of health professionals who can effectively carry out SBIRT (Screening, Brief Intervention, Referral to Treatment) practices in urban and rural medical settings throughout Oregon. The grant was awarded by the Substance Abuse Mental Health Services Administration (SAMHSA). Jim Winkle, MPH, Research Associate, will act as Project Manager.

The SBIRT Oregon Training Initiative will train at least 150 medical residents at OHSU, 405 social work students at Portland State University and 125 counseling students at Oregon State University-Cascades. By training a large number and wide variety of new SBIRT providers, and by demonstrating how they can best be integrated as teams in the patient-centered primary care medical home, the project will contribute to an environment in which addressing unhealthy use of substances becomes a normal part of healthcare in Oregon.  

SBIRT represents an innovative, evidence-based approach to addressing unhealthy substance use with primary care patients. Its core components entail: 

  • Regular and universal screening in the medical setting.
  • Systematic use of validated/standardized screening instruments.
  • Consideration of substance use as a continuum rather than a dichotomous "dependent versus not dependent" judgment.
  • Use of patient-centered change talk versus directive, prescriptive talk.
  • Facilitating smooth, bidirectional transitions between primary care and specialty addiction treatment.

The award comes an opportune time in Oregon Medicaid reform. Recognizing that prevention of alcohol and drug abuse and dependence will achieve cost savings, the Oregon Health Authority has mandated performance of SBIRT as one its priority Coordinated Care Organization (CCO) incentive measures, resulting in a sudden need to expand the number of clinical personnel in Oregon who can provide SBIRT services. In response, the new project will build a training curriculum to meet the needs of both medical clinicians and behavioral health specialists, producing a critical mass of medical professionals who can perform, implement and sustain evidence-based SBIRT practices into the future.

The School of Social Work at Portland State University will deliver a new SBIRT training curriculum to four distinct groups. Bachelors level students, who have traditionally stressed the need for additional training in this area of study, will complete a one-credit course. Campus-based Masters level students will be offered an advanced, three-credit elective that emphasizes a SBIRT-specific curriculum, while rural-based Masters level students will complete eight of 30 contact hours dedicated to SBIRT. Practicing social workers who supervise students will attend train-the-trainer sessions as part of their requirements for licensure. A modified, three-hour version of the SBIRT training curriculum will reach full- and part-time instructional faculty.

The OSU-Cascades Counseling Program in Bend will integrate the SBIRT training curriculum into a current Addictions and Motivational Interviewing course, as well as practicum and internship settings. Students in the Clinical Mental Health Counseling program will receive additional exposure to the SBIRT curriculum as part of the didactic and experiential portions of their practicum and internship experiences.  

At OHSU, Family Medicine residents (including Cascades East in Klamath Falls) and Internal Medicine residents will receive a new, two-hour SBIRT curriculum in their first year, followed by a refresher curriculum delivered each following year. These residents will practice in clinics where SBIRT processes are already in place. By training a diverse and large number of behaviorists and providers, the project will help integrate SBIRT into primary care settings, ensuring services provided are faithful to the intent of SBIRT and contribute towards a more cost-effective and comprehensive health-care system in the state of Oregon.