Course: Screening, Brief Intervention and Referral to Treatment

General

General
Screening, Brief Intervention and Referral to Treatment Homepage
Welcome to the Screening, Brief Intervention, and Referral to Treatment (SBIRT) course. This course provides you with the essential skills required to effectively identify, refer, and treat patients with substance use disorders and introduces a public health approach to substance use disorders. SBIRT is used to identify and deliver appropriate interventions for persons with existing substance use disorders and those at risk of developing a substance use disorder. This course also provides insights into addressing the stigma surrounding substance use, the screening process for high-risk behavior, delivery of brief interventions, and referral to treatment and includes an optional module that focuses on implementing SBIRT in a clinical care setting.
This Screening, Brief Intervention, and Referral to Treatment course is sponsored in part by the Annenberg Foundation Physician Training Program. This course has adopted learning resources from the Association of American Medical Colleges (AAMC) and John Hopkins University.
The course was designed by Cyrille Adam, B.A, BA, Ed; Eduardo Bianco, MD; Hugo Andres Rojas Aldieri, MD, MSc, DiplE; Pablo Baldiviezo Rodriguez, MD, DiplEd; Reisha Narine, BSc, MSc; Carolina Bustillos Ballivian, MD, DiplEd; Rhonda Prudent, BSc; Sara Wildman BSc and Sherian Bachan BSc, MSc.
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There are 5 modules to complete, including 1 optional module, which provides an introduction to:
Introduction to SBIRT

Motivational Interviewing Techniques

Screening

Brief Interventions

Referral to Treatment

Implementing SBIRT in Your Practice (Optional)

The completion time for this course is estimated at 47.2 hours, comprising 8 hours of learning resources, 24 hours to study content and assimilation, and 16 hours of participating in learning activities and quizzes to assist you in the synthesis of learning materials. This course is equivalent to 1 credit hour.

This course requires the completion of all activities. At the end of each module, there is a practice quiz of 10 multiple-choice questions. After you’ve completed each lesson, quiz, and learning activity, at the end of the course, you’ll have access to a final exam consisting of 40 multiple-choice questions and a chance to evaluate this course. You will have up to three opportunities to take the final exam and achieve the required score of >=70%. Once you’ve passed that last test, you will be able to download a certificate of completion from NextGenU.org and our course’s co-sponsoring organizations. We keep your personal information confidential, never sell any of your information, and only use anonymized data for research purposes. Also, we are happy to report your testing information and share your work with anyone (your school, employer, etc.) at your request.

Engaging with this course:

This free course is intended for primary health workers, physicians, nurses, medical students, and other health professionals who would like to learn more about the diagnosis, management, and treatment of substance use disorders in primary care settings.
To obtain a certificate, a learner must first register for the course and then successfully complete:

All the reading requirements;

All quizzes and pass with a 70% with unlimited attempts;

All reflection activities;

All discussion forums;

The final exam with a minimum of 70% and a maximum of 3 attempts;

The self and course evaluation forms.

To obtain credit:

Complete all requirements listed above for the certificate; and

Your learning institution or workplace should approve the partner-university-sponsored NextGenU.org course for educational credit, as they would for their learner taking a course anywhere.

To obtain a degree, NextGenU.org co-sponsors degree programs with institutional partners. To obtain a full degree co-sponsored with NextGenU.org, registrants must be enrolled in a degree program as a student of a NextGenU.org institutional partner. If you think that your institution might be interested in offering a degree with NextGenU.org, contact us.
We hope that you will find this a rewarding learning experience, and we count on your assessment and feedback to help us improve this training for future students.

Follow these steps to take the course and earn a certificate:

Complete the registration form;

Take the pre-test; and

Begin the course with Module 1: Introduction to SBIRT. In each lesson, read the description, complete all required readings and activities, and take the corresponding quizzes.
Module 1: Introduction to SBIRT
Upon the completion of this module, you will be able to:
- Define "screening," "brief intervention," and "referral to treatment."
- Define the concept of "risky use."
- Describe the spectrum of risky alcohol and drug use.
- Explain the prevalence and consequences of risky alcohol and drug use.
- Describe the prevention paradox.
- Identify the evidence supporting SBIRT.
- Describe the role of the stigma around the SUD.
- Know how to use person-centered language.
- Describe how an effective clinician conducts screening.
- Describe how an effective clinician conducts a brief intervention.
- Describe how an effective clinician conducts a referral.
Approximate time required for the readings for this module (at 144 words/minute): 9 hours and 40 minutes.

Click here to start this module.
1 SCORM package, 2 Forums, 1 Quiz
- Introduction to SBIRT SCORM package
  This Module content includes most of the information you will need to complete the quizzes and activities in this course. Be aware that some of the required readings are linked in the document and will be considered for the course assessments. Additionally, you will find some recommended readings to expand on your preferred topics.
- Reflection 1: A memorable experience with a patient Forum
  Narrative Reflection: In this learning activity, you will reflect on a memorable experience you have had talking with a patient about their substance use and answer questions regarding the interaction and what areas or issues you found to be challenging or rewarding.
  
  Step 1: Reflect
  
  Reflect on any memorable interaction you would have had with a patient regarding their substance use, paying attention to what would have made that particular interaction interesting, rewarding or challenging.
  
  Step 2: Respond
  
  Prepare a 300-400 word reflection discussing the following key points as it relates to your interaction with the patient:
  
  A brief description of the interaction
  
  What did you find rewarding and/or challenging about this encounter?
  
  What people or resources helped you care for this patient? How?
  
  What do you wish you could have done differently with this patient?
  
  What questions or insights does this reflection exercise bring to mind about addressing substance issues with your patients?
  
  Step 3: Share [10 minutes]
  
  To share your work, click on the “Add a new discussion topic” button under this post and paste your work into the “Message” box. Make sure to reference others’ intellectual property when necessary. All references should follow 7th Edition APA formatting. For further instructions, see the resource on the Himmelfarb Health Sciences Library: APA citation resource (N.B. references are excluded from word counts).
  
  Step 4: Interact [10 minutes]
  
  To complete the activity, you will need to reply to at least two posts made by your peers in a respectful and professional manner. Be sure that your post engages your peers' ideas by including a reflection on their comments, sharing ideas on other potential difficulties and parties involved, or asking thought-provoking questions. If a peer comments on your posting, please reply. To post a reply, click “Reply” on a particular discussion, write your feedback and then click on “Post to forum.”
- Reflection 2: Understanding Substance Use and Stigma Forum
  Reflection: In this learning activity, you will discuss the prevalence of substance use in your practice or clinical setting and the stigma surrounding it.
  Step 1: Review and Reflect
  Review the statement below and watch the video:
  “At Boston University: Physicians reported that 24% of their patients had alcohol abuse or dependence and 15% had drug abuse or dependence.”
  
  Reflect on your clinical experience to answer questions as it relates to the prevalence and risk of substance use and the stigma surrounding its use.
  Based on the statement, consider that you have ten patients on your next clinic schedule.
  Step 2: Respond
  Prepare a 400-500 word reflection discussing the following key points:
  How common are these various problems?
  
  What’s the spectrum of alcohol or drug use in your patients?
  
  Out of those 10 patients you are expected to see in a day, how many would you estimate have a substance use disorder versus risky use?
  
  How has stigma been observed in your practice?
  
  How does it affect patients seeking treatment?
  
  Why is using appropriate and people-centered language important?
  
  How have you sought to reduce or minimize the stigma associated with substance use?
  
  Step 3: Share [10 minutes]
  
  To share your work, click on the “Add a new discussion topic” button under this post and paste your work into the “Message” box. Make sure to reference others’ intellectual property when necessary. All references should follow 7th Edition APA formatting. For further instructions, see the resource on the Himmelfarb Health Sciences Library: APA citation resource (N.B. references are excluded from word counts).
  
  Step 4: Interact [10 minutes]
  
  To complete the activity, you will need to reply to at least two posts made by your peers in a respectful and professional manner. Be sure that your post engages your peers' ideas by including a reflection on their comments, sharing ideas on other potential difficulties and parties involved, or asking thought-provoking questions. If a peer comments on your posting, please reply. To post a reply, click “Reply” on a particular discussion, write your feedback and then click on “Post to forum.”
- Quiz: Module 1
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the attempt quiz button to view the case studies and respond to the questions.
Module 2: Motivational Interviewing Techniques
Upon completion of this module, you will be able to:
- Describe the elements and characteristics of MI spirit and why it is effective.
- Recognize OARS as important MI skills.
- Demonstrate how to use OARS (open-ended questions, affirmations, reflections, summaries) as part of SBIRT.
- Recognize ambivalence, change and sustain talk.
- Describe ways to elicit change talk and respond to it.
- Know how to assess importance/confidence/readiness to change with a ruler.
Approximate time required for the readings for this lesson (at 144 words/minute): 11 hours and 39 minutes.

Click here to start this module.
1 SCORM package, 1 Forum, 1 Quiz
- Motivational Interviewing Techniques SCORM package
  This Module content includes most of the information you will need to complete the quizzes and activities in this course. Be aware that some of the required readings are linked in the document and will be considered for the course assessments. Additionally, you will find some recommended readings to expand on your preferred topics.
- Reflection 3: Motivational interviewing techniques (120 minutes) Forum
  Brief Reflection: In this learning activity, you will watch the video below on motivational interviewing and then reflect on your clinical experiences to answer questions about the challenges and benefits of using the motivational interviewing technique on patients with substance use disorders.
  Step 1: Review and Reflect
  Watch the video on motivational interviewing and reflect on how it is used with patients with substance use disorders or at risk of developing a substance use disorder.
  
  Step 2: Respond
  Prepare a 250- 350 word reflection discussing the use of the motivational interviewing technique. Ensure that your response includes the following key points:
  Challenges faced in talking to patients about alcohol or drug use.
  
  The opportunities and benefits of using the Motivational Interviewing technique with your patients.
  
  How do you plan to apply/implement the knowledge gained in this lesson to effectively interact with patients about their alcohol or drug use?
  
  Step 3: Share
  
  To share your work, click on the “Add a new discussion topic” button under this post and paste your work into the “Message” box. Make sure to reference others’ intellectual property when necessary. All references should follow 7th Edition APA formatting. For further instructions, see the resource on the Himmelfarb Health Sciences Library: APA citation resource (N.B. references are excluded from word counts).
  
  Step 4: Interact
  
  To complete the activity, you will need to reply to at least two posts made by your peers in a respectful and professional manner. Be sure that your post engages your peers' ideas by including a reflection on their comments, sharing ideas on other potential difficulties and parties involved, or asking thought-provoking questions. If a peer comments on your posting, please reply. To post a reply, click “Reply” on a particular discussion, write your feedback and then click on “Post to forum.”
- Quiz: Module 2
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the attempt quiz button to view the case studies and respond to the questions.
Module 3: Screening
Upon completion of this module, you will be able to:
- Understand universal screening and its relevance.
- Describe SBIRT screening steps, including introducing/normalizing screening for substance use, defining a standard drink, and conducting prescreening and full screening.
- Appropriately select and use screening tools [CAGE; NIAAA single-question prescreen; quantity-frequency prescreen questions; AUDIT; AUDIT-C; single-question drug prescreen; DAST].
- Describe screening considerations focused on specific populations [people under age 21, pregnant women, people with comorbidities, older adult population].
- Discuss non-stigmatizing approaches and adaptations for screening among specific populations.
Approximate time required for the readings for this lesson (at 144 words/minute): 8 hours and 25 minutes.

Click here to start this module.
2 SCORM packages, 1 Forum, 1 Quiz
- Required Learning Resources and Activities
- Screening SCORM package
  This Module content includes most of the information you will need to complete the quizzes and activities in this course. Be aware that some of the required readings are linked in the document and will be considered for the course assessments. Additionally, you will find some recommended readings to expand on your preferred topics.
- Discussion Forum 1: Implementing screening skills (120 minutes)
  Discussion: In this learning activity, you will reflect on all you have learned in this module and answer questions as it relates to the screening process and using screening tools.
  Step 1: Review
  Review all the required learning materials for this lesson.
  Step 2: Respond
  Prepare a 250-400 word piece of writing which answers the following key questions:
  What are the pros of using standardized and validated screening tools?
  
  What are the cons of using standardized and validated screening tools?
  
  How can you imagine conducting screening & assessment in your own clinic?
  
  What drawbacks and facilitators for implementing standardized screenings does your clinic present?
  
  Step 3: Share
  
  To share your work, click on the “Add a new discussion topic” button under this post and paste your work into the “Message” box. Make sure to reference others’ intellectual property when necessary. All references should follow 7th Edition APA formatting. For further instructions, see the resource on the Himmelfarb Health Sciences Library: APA citation resource (N.B. references are excluded from word counts).
  
  Step 4: Interact
  
  To complete the activity, you will need to reply to at least two posts made by your peers in a respectful and professional manner. Be sure that your post engages your peers' ideas by including a reflection on their comments, sharing ideas on other potential difficulties and parties involved, or asking thought-provoking questions. If a peer comments on your posting, please reply. To post a reply, click “Reply” on a particular discussion, write your feedback and then click on “Post to forum.
- Case Study 1: Addressing substance use in pregnancy SCORM package
  In this activity, you can navigate the slides by moving back and forth, selecting left or right arrows.
  You must pass the quizzes for the activity to be marked as complete, and you will have unlimited attempts to complete the activity.
- Quiz: Module 3
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the attempt quiz button to view the case studies and respond to the questions.
Module 4: Brief Interventions
Upon completion of this module, you will be able to:
- Understand what brief interventions are and what they try to accomplish.
- Know what agencies endorse the use of brief interventions.
- Examine some of the evidence for the effectiveness of brief interventions for various substances.
- Raise the subject.
- Provide appropriate feedback.
- Enhance motivation (including the pros and cons).
- Negotiate a plan.
Approximate time required for the readings for this lesson (at 144 words/minute): 4 hours and 43 minutes.

Click here to start this module.
2 SCORM packages, 1 Quiz
- Brief Interventions SCORM package
  This Module content includes most of the information you will need to complete the quizzes and activities in this course. Be aware that some of the required readings are linked in the document and will be considered for the course assessments. Additionally, you will find some recommended readings to expand on your preferred topics.
- Case Study 2: 35 y.o patient who drinks over the guidelines visits his primary care physician SCORM package
  In this activity, you can navigate the slides by moving back and forth, selecting left or right arrows.
  You must pass the quizzes for the activity to be marked as complete, and you will have unlimited attempts to complete the activity.
- Quiz: Module 4
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the attempt quiz button to view the case studies and respond to the questions.
Module 5: Referral to Treatment
Upon completion of this module, you will be able to:
- Describe the steps to make a successful referral to treatment.
- Identify the treatment options for alcohol use disorder and opioid use disorder.
- Review the barriers and facilitators to successful treatment referrals.
- Describe what constitutes a warm hand-off.
- Review the evidence for warm hand-offs.
Approximate time required for the readings for this lesson (at 144 words/minute): 6 hours.

Click here to start this module.
2 SCORM packages, 1 Forum, 1 Quiz
- Referral to Treatment SCORM package
  This Module content includes most of the information you will need to complete the quizzes and activities in this course. Be aware that some of the required readings are linked in the document and will be considered for the course assessments. Additionally, you will find some recommended readings to expand on your preferred topics.
- Case Study 3: Marcia and Marcus' Cases SCORM package
  In this activity, you can navigate the slides by moving back and forth, selecting left or right arrows.
  You must pass the quizzes for the activity to be marked as complete, and you will have unlimited attempts to complete the activity.
- Discussion Forum 2: Understanding Factors to referral (120 minutes)
  Reflection: In this learning activity, you will reflect on your clinical experience of interacting with and referring patients with substance use disorders and discuss points related to barriers and facilitators to successful treatment referrals.
  Step 1: Review and Reflect
  Review all the required material for this lesson and then reflect on challenges and facilitators you have encountered in interacting with patients and referring them to treatment.
  Step 2: Respond
  Prepare a 250-300 reflection which answers the following key questions:
  What common barriers to effective referral to treatment have you observed in your setting/practice?
  How have you responded to these barriers?
  What facilitators for referral to treatment have you observed in your setting/practice?
  What measures can be used/have you used to help overcome barriers to treatments?
  Step 3: Share
  To share your work, click on the “Add a new discussion topic” button under this post and paste your work into the “Message” box. Make sure to reference others’ intellectual property when necessary. All references should follow 7th Edition APA formatting. For further instructions, see the resource on the Himmelfarb Health Sciences Library: APA citation resource (N.B. references are excluded from word counts).
  Step 4: Interact
  To complete the activity, you will need to reply to at least two posts made by your peers in a respectful and professional manner. Be sure that your post engages your peers' ideas by including a reflection on their comments, sharing ideas on other potential difficulties and parties involved, or asking thought-provoking questions. If a peer comments on your posting, please reply. To post a reply, click “Reply” on a particular discussion, write your feedback and then click on “Post to forum.”
- Quiz: Module 5
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the attempt quiz button to view the case studies and respond to the questions.
Module 6: Implementing SBIRT in Your Practice (Optional)
Upon completion of this module, you will be able to:

Describe the process of implementing SBIRT in healthcare settings, including its barriers and facilitators.

Examine the evidence for the effective implementation of SBIRT in certain contexts and circumstances.

Apply the implementation process of SBIRT in your own practice.

Approximate time required for the readings for this lesson (at 144 words/minute): 4 hours and 8 minutes.

Click here to start this module.
1 SCORM package, 1 Quiz, 1 Forum
- Implementing SBIRT in your Practice SCORM package
  This Module content includes most of the information you will need to complete the quizzes and activities in this course. Be aware that some of the required readings are linked in the document and will be considered for the course assessments. Additionally, you will find some recommended readings to expand on your preferred topics.
- Quiz: Module 6
  To access the quiz, click on the name of the quiz provided above. On the following screen, click the attempt quiz button to view the case studies and respond to the questions.
- Reflection 4: Implementing SBIRT in your clinical-care setting (150 mins) Forum
  Reflection - In this learning activity, you will reflect on all you have learned in this module and answer questions as it relates to the implementation of SBIRT in your clinical-care setting/practice.
  Step 1: Review and Reflect
  Review all the required learning materials for this lesson and reflect on the feasibility of implementing SBIRT in your clinical-care setting.
  Step 2: Respond
  Prepare a 300-450 word piece of writing which answers the following key questions based on your practice/clinical setting:
  What are contextual factors which will influence the implementation of SBIRT?
  What do you think might be some possible obstacles and facilitators to implementing SBIRT in your clinic?
  What are the general benefits of implementing SBIRT in the health care setting?
  Step 3: Share
  To share your work, click on the “Add a new discussion topic” button under this post and paste your work into the “Message” box. Make sure to reference others’ intellectual property when necessary. All references should follow 7th Edition APA formatting. For further instructions, see the resource on the Himmelfarb Health Sciences Library: APA citation resource (N.B. references are excluded from word counts).
Final Exam

Click here to start the Final Examination.
- Final Exam Quiz
  Restricted Not available unless:
  All of:
  The activity (Missing activity) is marked complete
  The activity Pre-Test is marked complete
  The activity Quiz: Module 1 is marked complete
  The activity Quiz: Module 2 is marked complete
  The activity Quiz: Module 3 is marked complete
  The activity Quiz: Module 4 is marked complete
  The activity Quiz: Module 5 is marked complete
  All of:
  The activity Reflection 1: A memorable experience with a patient is marked complete
  The activity Reflection 2: Understanding Substance Use and Stigma is marked complete
  The activity Reflection 3: Motivational interviewing techniques (120 minutes) is marked complete
  The activity Discussion Forum 1: Implementing screening skills (120 minutes) is marked complete
  The activity Discussion Forum 2: Understanding Factors to referral (120 minutes) is marked complete
  The activity Case Study 1: Addressing substance use in pregnancy is marked complete
  The activity Case Study 2: 35 y.o patient who drinks over the guidelines visits his primary care physician is marked complete
  The activity Case Study 3: Marcia and Marcus' Cases is marked complete
  
  To take the final exam, you must complete all quizzes and complete all the required activities. The final exam consists of ---- questions, and you will have ---- minutes to complete it. When the time is over, you will have two minutes to submit your attempt before it expires, and your progress is discarded. You will not be able to answer additional questions in the grace period.
  To access the exam, click on the name of the exam provided above. On the following screen, click the attempt quiz button to respond to the questions.
Course and Self Evaluation and Certificate

In this section, you can provide feedback about this course to help us make NextGenU.org better. Once evaluations have been completed, you will be able to download your certificate of completion.

Click here to give your feedback.
- Course Evaluation Questionnaire
  Restricted Not available unless: The activity Final Exam is marked complete
- Self Evaluation Questionnaire
  Restricted Not available unless: The activity Final Exam is marked complete
Course Activities

4 Pages

Upon the completion of this module, you will be able to:

Upon completion of this module, you will be able to:

Upon completion of this module, you will be able to:

Required Learning Resources and Activities

Upon completion of this module, you will be able to:

Upon completion of this module, you will be able to:

Upon completion of this module, you will be able to: