Screening, brief intervention and referral to treatment: Difference between revisions
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'''<u>S</u>creening, <u>B</u>rief <u>I</u>ntervention and <u>R</u>eferral to <u>T</u>reatment''' (SBIRT) is a model that encourages mental health and substance abuse screenings as a routine preventive service in healthcare. |
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== Background == |
== Background == |
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[[File:SBIRT.jpg|thumb|Screening, Brief Intervention and Referral to Treatment ]] |
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Screening, brief intervention and referral to treatment is an evidence-based, public health approach aimed at delivering early intervention and treatment services for individuals at risk of developing [[Substance use disorder|substance use disorders]] (SUDs) and those who have already developed these disorders.<ref name=":0">{{Cite journal|last=Agerwala|first=Suneel M.|date=2012|title=Integrating Screening, Brief Intervention, and Referral to Treatment (SBIRT) into Clinical Practice Settings: A Brief Review|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3801194/|journal=J Psychoactive Drugs|volume=44|pages=307-317|via=PMC}}</ref> |
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Unhealthy and unsafe alcohol and drug use are major preventable public health problems resulting in 3 million deaths every year, worldwide, as reported by WHO.<ref>{{Cite web|url=https://www.who.int/news-room/fact-sheets/detail/alcohol|title=Alcohol|website=www.who.int|language=en|access-date=2019-06-21}}</ref> Research shows SBIRT to be most effective with patients with unhealthy alcohol or drug use who do not have a substance use disorder, <ref>{{Cite journal|last=|first=|date=|title=Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: recommendation statement|url=https://www.ncbi.nlm.nih.gov/pubmed/15068984|journal=|volume=|pages=|via=}}</ref> therefore, the primary goal of SBIRT is intended to reduce the harms and societal costs associated with the risky use of such substances, before the problem elevates to a disorder. |
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| ⚫ | The SBIRT model was developed by the [[Institute Of Medicine|Institute of Medicine]] as a result of a recommendation that encouraged community-based screening for health risk behaviours, including substance use. Unhealthy and unsafe alcohol and drug use are major preventable [[public health]] problems resulting in 3 million deaths every year worldwide, as reported by [[World Health Organization|WHO]].<ref>{{Cite web|url=https://www.who.int/news-room/fact-sheets/detail/alcohol|title=Alcohol|website=www.who.int|language=en|access-date=2019-06-20}}</ref> Research shows SBIRT to be most effective with patients with unhealthy alcohol or drug use who do not have a substance use disorder; therefore, the primary goal of SBIRT is intended to reduce the harms and societal costs associated with the risky use of such substances before the problem elevates to a disorder.<ref>{{Cite web|url=https://www.integration.samhsa.gov/clinical-practice/SBIRT#why?|title=SBIRT / SAMHSA-HRSA|website=www.integration.samhsa.gov|access-date=2019-06-21}}</ref> |
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== Three major components == |
== Three major components == |
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=== Screening === |
=== Screening === |
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Screening in primary care settings is recommended by the U.S. Preventative Services Task Force for alcohol misuse accompanied with brief behavioral counseling interventions for those engaged in risky or hazardous drinking to reduce alcohol misuse.<ref>{{Cite web|url=https://www.uspreventiveservicestaskforce.org/Page/Name/recommendations|title=Recommendations for Primary Care Practice - US Preventive Services Task Force|website=www.uspreventiveservicestaskforce.org|access-date=2019-06-21}}</ref> |
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Screening quickly assesses the severity of substance use by and usually accompanies tailored feedback and advice.<ref>{{Cite web|url=https://www.samhsa.gov/sbirt|title=SBIRT|last=michelle.harrington|date=2014-04-03|website=www.samhsa.gov|language=en|access-date=2019-06-20}}</ref> Simple feedback on risky behavior can be one of the most important influences on patient behavior and change.<ref>{{Cite journal|last=McCarty|first=Carolyn A.|last2=Whitehouse|first2=Sandy|last3=Spielvogle|first3=Heather|last4=Katzman|first4=Katherine|last5=Richardson|first5=Laura P.|last6=Zieve|first6=Garret G.|date=2017|title=Adolescents’ Perspectives on Personalized E-Feedback in the Context of Health Risk Behavior Screening for Primary Care: Qualitative Study|url=https://www.jmir.org/2017/7/e261/|journal=Journal of Medical Internet Research|language=en|volume=19|issue=7|pages=e261|doi=10.2196/jmir.7474}}</ref> Screening large numbers of individuals present an opportunity to engage those who are in need of treatment and refer them to correct resources. Universal, annual Screening identifies unhealthy use of alcohol and drugs, and it s reported that 75-85% of patients will screen negative.<ref>{{Cite journal|last=Beich|first=A|date=2007|title=Screening and brief intervention targeting risky drinkers in Danish general practice--a pragmatic controlled trial.|url=https://www.ncbi.nlm.nih.gov/pubmed/17855332/|journal=Oxford Academic|volume=|pages=|via=}}</ref> For those who screen positive, further assessment is needed to determine the level of risk associated with their use. |
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Screening quickly assesses the severity of substance use and usually accompanies tailored feedback on risky behavior,<ref>{{Cite web|url=https://www.samhsa.gov/sbirt|title=SBIRT|last=michelle.harrington|date=2014-04-03|website=www.samhsa.gov|language=en|access-date=2019-06-21}}</ref> which can greatly influence patient behavior. <ref>{{Cite journal|last=McCarty|first=Carolyn A.|last2=Whitehouse|first2=Sandy|last3=Spielvogle|first3=Heather|last4=Katzman|first4=Katherine|last5=Richardson|first5=Laura P.|last6=Zieve|first6=Garret G.|date=2017|title=Adolescents’ Perspectives on Personalized E-Feedback in the Context of Health Risk Behavior Screening for Primary Care: Qualitative Study|url=https://www.jmir.org/2017/7/e261/|journal=Journal of Medical Internet Research|language=en|volume=19|issue=7|pages=e261|doi=10.2196/jmir.7474}}</ref> Screening large numbers of individuals present an opportunity to engage those who are in need of treatment and refer them to correct resources. Efforts to provide an evidence base for alcohol screening and brief intervention in primary health care settings have been started since the 1980s in the US and the World Health Organization. <ref>{{Cite journal|last=Babor|first=|date=2007|title=Screening, Brief Intervention, and Referral to Treatment (SBIRT): toward a public health approach to the management of substance abuse.|url=https://www.ncbi.nlm.nih.gov/pubmed/18077300|journal=Substance Abuse|volume=28|pages=|via=}}</ref> This research led to the development of reliable screening tools for alcohol and drug abuse, such as the [[Michigan Alcoholism Screening Test|Michigan Alcohol Screening Test,]] the [[CAGE questionnaire|CAGE]], and the Drug Abuse Screening Test. <ref>{{Cite journal|last=Babor|first=Thomas F.|last2=Kadden|first2=Ronald M.|date=2005-09|title=Screening and Interventions for Alcohol and Drug Problems in Medical Settings: What Works?|url=http://dx.doi.org/10.1097/01.ta.0000174664.88603.21|journal=The Journal of Trauma: Injury, Infection, and Critical Care|volume=59|issue=Supplement|pages=S80–S87|doi=10.1097/01.ta.0000174664.88603.21|issn=0022-5282}}</ref> Research also extended to understanding the best mode of administration of such screening assessments, as part of a clinician interview via a questionnaire, or electronically. Using computers as a means of screening has been in evolution for two decades and recent studies have shown promise for this method. <ref>{{Cite journal|last=Riper|first=Heleen|last2=Kramer|first2=Jeannet|last3=Smit|first3=Filip|last4=Conijn|first4=Barbara|last5=Schippers|first5=Gerard|last6=Cuijpers|first6=Pim|date=2008-02|title=Web-based self-help for problem drinkers: a pragmatic randomized trial|url=http://dx.doi.org/10.1111/j.1360-0443.2007.02063.x|journal=Addiction|volume=103|issue=2|pages=218–227|doi=10.1111/j.1360-0443.2007.02063.x|issn=0965-2140}}</ref> <ref>{{Cite journal|last=Linke|first=Stuart|last2=McCambridge|first2=Jim|last3=Khadjesari|first3=Zarnie|last4=Wallace|first4=Paul|last5=Murray|first5=Elizabeth|date=2008|title=Development of a Psychologically Enhanced Interactive Online Intervention for Hazardous Drinking|url=http://dx.doi.org/10.1093/alcalc/agn066|journal=Alcohol and Alcoholism|volume=43|issue=6|pages=669–674|doi=10.1093/alcalc/agn066|issn=0735-0414}}</ref> <ref>{{Cite journal|last=Kypri|first=Kypros|date=2008-03-10|title=Randomized Controlled Trial of Web-Based Alcohol Screening and Brief Intervention in Primary Care|url=http://dx.doi.org/10.1001/archinternmed.2007.109|journal=Archives of Internal Medicine|volume=168|issue=5|pages=530|doi=10.1001/archinternmed.2007.109|issn=0003-9926}}</ref> <ref>{{Cite journal|last=McCarty|first=Carolyn A.|last2=Whitehouse|first2=Sandy|last3=Spielvogle|first3=Heather|last4=Katzman|first4=Katherine|last5=Richardson|first5=Laura P.|last6=Zieve|first6=Garret G.|date=2017|title=Adolescents’ Perspectives on Personalized E-Feedback in the Context of Health Risk Behavior Screening for Primary Care: Qualitative Study|url=https://www.jmir.org/2017/7/e261/|journal=Journal of Medical Internet Research|language=en|volume=19|issue=7|pages=e261|doi=10.2196/jmir.7474}}</ref> One such study examined the effect of electronic screening with personalized feedback on adolescent health risk behaviours in a primary care setting. In a randomized clinical trial, involving 300 youth randomly assigned to receive screening through an electronic screening tool called ''[[Check Yourself Screening Tool|Check Yourself]]'' with personalized feedback vs usual care, youths who received the electronic screening intervention were more likely than controls to receive risk counseling and also, scored lower on risk behavior. <ref>{{Cite journal|last=McCarty|first=Carolyn A.|last2=Taylor|first2=James A.|last3=Spielvogle|first3=Heather|last4=Gersh|first4=Elon|last5=Zhou|first5=Chuan|last6=Richardson|first6=Laura P.|date=2019-05-03|title=Effect of Electronic Screening With Personalized Feedback on Adolescent Health Risk Behaviors in a Primary Care Setting: A Randomized Clinical Trial|url=https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2733175|journal=JAMA Network Open|language=en|volume=2|issue=5|pages=e193581–e193581|doi=10.1001/jamanetworkopen.2019.3581}}</ref> |
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Evidence supporting the effectiveness of screening in primary care settings continues to grow and the positive evidence from this research has encouraged national demonstration programs in the US to control substance abuse, such as King County’s [[Check Yourself Screening Tool|Best Start for Kids]]. In the United States, the dissemination of SBIRT technologies has been strongly supported by SAMHSA’s SBIRT initiative. <ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3801194/#R5|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref> Universal, annual screening identifies unhealthy use of alcohol and drugs, and it's reported that 75-85% of patients will screen negative.<ref>{{Cite web|url=https://www.reading.k12.ma.us/files/3414/7120/7567/SA3522_sbirt_for_clinicians.pdf|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref> For those who screen positive, further assessment is needed to determine the level of risk associated with their use. |
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=== Brief intervention === |
=== Brief intervention === |
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The brief intervention aims at providing detailed feedback, which focuses on increasing insight and awareness regarding substance use and instills motivation towards |
Following the screening, if it is determined that individuals substance use is hazardous, brief intervention is conducted. The brief intervention aims at providing detailed feedback, which focuses on increasing insight and awareness regarding substance use and instills motivation towards behavioral change. <ref>{{Cite web|url=https://sites.education.miami.edu/sbirt/what-is-sbirt/|title=What is SBIRT? – SBIRT|language=en-US|access-date=2019-06-21}}</ref> Originally, the brief intervention utilized brief advice approaches, whereas current U.S. SBIRT efforts focus on motivational interviewing approaches of various lengths. <ref>{{Cite journal|last=Pringle|first=Janice L.|last2=Kowalchuk|first2=Alicia|last3=Meyers|first3=Jessica Adams|last4=Seale|first4=J. Paul|date=2012-03|title=Equipping Residents to Address Alcohol and Drug Abuse: The National SBIRT Residency Training Project|url=http://dx.doi.org/10.4300/jgme-d-11-00019.1|journal=Journal of Graduate Medical Education|volume=4|issue=1|pages=58–63|doi=10.4300/jgme-d-11-00019.1|issn=1949-8349}}</ref> Intervention usually includes giving feedback on the risks and negative consequences of substance use, advising on modifying alcohol and drug use and suggestions options to choose from to modify risky behavior, hence encouraging the individual to exercise decision making. |
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An important strategy used to conduct Brief Intervention is FRAMES<ref>{{Cite journal|last=Thomas|first=Bied|date=1993|title=Brief interventions for alcohol problems: a review|url=https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1360-0443.1993.tb00820.x|journal=|volume=|pages=|via=}}</ref>; '''<u>F</u>'''eedback on the risk for alcohol problems, '''<u>R</u>'''esponsibility: where the individual with alcohol misuse is responsible for change, '''<u>A</u>'''dvice: about reduction or explicit direction to change, '''<u>M</u>'''enu: providing a variety of strategies for change, '''<u>E</u>'''mpathy: with a warm, reflective, empathic and understanding approach and '''<u>S</u>'''elf-efficacy of the misusing person in making a change. |
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=== Referral to treatment === |
=== Referral to treatment === |
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In cases where brief intervention has shown to have a little effect, the individuals are referred to treatment. A referral is usually indicated for only about 5% of people screened.<ref>{{Cite web|url=https://www.masbirt.org/sites/www.masbirt.org/files/documents/toolkit.pdf|title=SBIRT: Step by Step Guide|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref> |
In cases where brief intervention has shown to have a little effect, the individuals are referred to treatment. A referral is usually indicated for only about 5% of people screened.<ref>{{Cite web|url=https://www.masbirt.org/sites/www.masbirt.org/files/documents/toolkit.pdf|title=SBIRT: Step by Step Guide|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref> |
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== Applications == |
== Applications & Implementation of SBIRT == |
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The applications of SBIRT are very flexible so it can be delivered in various settings, including, primary care centres, [[School-based health centers|school-based health centers,]] clinics, and other community settings provide excellent opportunities for early intervention with at-risk substance users and for intervention for persons with substance use disorders.<ref name=":0" /> |
The applications of SBIRT are very flexible so it can be delivered in various settings, including, primary care centres, [[School-based health centers|school-based health centers,]] clinics, and other community settings provide excellent opportunities for early intervention with at-risk substance users and for intervention for persons with substance use disorders.<ref name=":0" /> SBIRT has proved its importance in many medical settings in facilitating early identification of risky substance use, therefore many recent studies are exploring new approaches to understanding SBIRT and how best to implement the intervention to achieve the greatest positive results. |
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<br /> |
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== References == |
== References == |
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Revision as of 22:40, 21 June 2019
Screening, Brief Intervention and Referral to Treatment (SBIRT) is a model that encourages mental health and substance abuse screenings as a routine preventive service in healthcare.
Background
Screening, brief intervention and referral to treatment is an evidence-based, public health approach aimed at delivering early intervention and treatment services for individuals at risk of developing substance use disorders (SUDs) and those who have already developed these disorders.[1]
Unhealthy and unsafe alcohol and drug use are major preventable public health problems resulting in 3 million deaths every year, worldwide, as reported by WHO.[2] Research shows SBIRT to be most effective with patients with unhealthy alcohol or drug use who do not have a substance use disorder, [3] therefore, the primary goal of SBIRT is intended to reduce the harms and societal costs associated with the risky use of such substances, before the problem elevates to a disorder.
The SBIRT model was developed by the Institute of Medicine as a result of a recommendation that encouraged community-based screening for health risk behaviours, including substance use. Unhealthy and unsafe alcohol and drug use are major preventable public health problems resulting in 3 million deaths every year worldwide, as reported by WHO.[4] Research shows SBIRT to be most effective with patients with unhealthy alcohol or drug use who do not have a substance use disorder; therefore, the primary goal of SBIRT is intended to reduce the harms and societal costs associated with the risky use of such substances before the problem elevates to a disorder.[5]
Three major components
As explained by SAMHSA (Substance Abuse and Mental Health Services Administration), SBIRT consists of three major components:
- Screening: A healthcare professional assesses a patient for risky substance use behaviours using standardized screening tools in any healthcare and school-based healthcare setting.
- Brief Intervention: A healthcare professional engages a patient showing risky substance use behaviours in a short conversation, providing feedback and advice.
- Referral to treatment: A healthcare professional provides a referral to brief therapy or additional treatment to patients who screen in need of additional services
Screening
Screening in primary care settings is recommended by the U.S. Preventative Services Task Force for alcohol misuse accompanied with brief behavioral counseling interventions for those engaged in risky or hazardous drinking to reduce alcohol misuse.[6]
Screening quickly assesses the severity of substance use and usually accompanies tailored feedback on risky behavior,[7] which can greatly influence patient behavior. [8] Screening large numbers of individuals present an opportunity to engage those who are in need of treatment and refer them to correct resources. Efforts to provide an evidence base for alcohol screening and brief intervention in primary health care settings have been started since the 1980s in the US and the World Health Organization. [9] This research led to the development of reliable screening tools for alcohol and drug abuse, such as the Michigan Alcohol Screening Test, the CAGE, and the Drug Abuse Screening Test. [10] Research also extended to understanding the best mode of administration of such screening assessments, as part of a clinician interview via a questionnaire, or electronically. Using computers as a means of screening has been in evolution for two decades and recent studies have shown promise for this method. [11] [12] [13] [14] One such study examined the effect of electronic screening with personalized feedback on adolescent health risk behaviours in a primary care setting. In a randomized clinical trial, involving 300 youth randomly assigned to receive screening through an electronic screening tool called Check Yourself with personalized feedback vs usual care, youths who received the electronic screening intervention were more likely than controls to receive risk counseling and also, scored lower on risk behavior. [15] Evidence supporting the effectiveness of screening in primary care settings continues to grow and the positive evidence from this research has encouraged national demonstration programs in the US to control substance abuse, such as King County’s Best Start for Kids. In the United States, the dissemination of SBIRT technologies has been strongly supported by SAMHSA’s SBIRT initiative. [16] Universal, annual screening identifies unhealthy use of alcohol and drugs, and it's reported that 75-85% of patients will screen negative.[17] For those who screen positive, further assessment is needed to determine the level of risk associated with their use.
Brief intervention
Following the screening, if it is determined that individuals substance use is hazardous, brief intervention is conducted. The brief intervention aims at providing detailed feedback, which focuses on increasing insight and awareness regarding substance use and instills motivation towards behavioral change. [18] Originally, the brief intervention utilized brief advice approaches, whereas current U.S. SBIRT efforts focus on motivational interviewing approaches of various lengths. [19] Intervention usually includes giving feedback on the risks and negative consequences of substance use, advising on modifying alcohol and drug use and suggestions options to choose from to modify risky behavior, hence encouraging the individual to exercise decision making.
An important strategy used to conduct Brief Intervention is FRAMES[20]; Feedback on the risk for alcohol problems, Responsibility: where the individual with alcohol misuse is responsible for change, Advice: about reduction or explicit direction to change, Menu: providing a variety of strategies for change, Empathy: with a warm, reflective, empathic and understanding approach and Self-efficacy of the misusing person in making a change.
Referral to treatment
In cases where brief intervention has shown to have a little effect, the individuals are referred to treatment. A referral is usually indicated for only about 5% of people screened.[21]
Applications & Implementation of SBIRT
The applications of SBIRT are very flexible so it can be delivered in various settings, including, primary care centres, school-based health centers, clinics, and other community settings provide excellent opportunities for early intervention with at-risk substance users and for intervention for persons with substance use disorders.[1] SBIRT has proved its importance in many medical settings in facilitating early identification of risky substance use, therefore many recent studies are exploring new approaches to understanding SBIRT and how best to implement the intervention to achieve the greatest positive results.
References
- ^ a b Agerwala, Suneel M. (2012). "Integrating Screening, Brief Intervention, and Referral to Treatment (SBIRT) into Clinical Practice Settings: A Brief Review". J Psychoactive Drugs. 44: 307–317 – via PMC.
- ^ "Alcohol". www.who.int. Retrieved 2019-06-21.
- ^ "Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: recommendation statement".
{{cite journal}}: Cite journal requires|journal=(help) - ^ "Alcohol". www.who.int. Retrieved 2019-06-20.
- ^ "SBIRT / SAMHSA-HRSA". www.integration.samhsa.gov. Retrieved 2019-06-21.
- ^ "Recommendations for Primary Care Practice - US Preventive Services Task Force". www.uspreventiveservicestaskforce.org. Retrieved 2019-06-21.
- ^ michelle.harrington (2014-04-03). "SBIRT". www.samhsa.gov. Retrieved 2019-06-21.
- ^ McCarty, Carolyn A.; Whitehouse, Sandy; Spielvogle, Heather; Katzman, Katherine; Richardson, Laura P.; Zieve, Garret G. (2017). "Adolescents' Perspectives on Personalized E-Feedback in the Context of Health Risk Behavior Screening for Primary Care: Qualitative Study". Journal of Medical Internet Research. 19 (7): e261. doi:10.2196/jmir.7474.
{{cite journal}}: CS1 maint: unflagged free DOI (link) - ^ Babor (2007). "Screening, Brief Intervention, and Referral to Treatment (SBIRT): toward a public health approach to the management of substance abuse". Substance Abuse. 28.
- ^ Babor, Thomas F.; Kadden, Ronald M. (2005-09). "Screening and Interventions for Alcohol and Drug Problems in Medical Settings: What Works?". The Journal of Trauma: Injury, Infection, and Critical Care. 59 (Supplement): S80–S87. doi:10.1097/01.ta.0000174664.88603.21. ISSN 0022-5282.
{{cite journal}}: Check date values in:|date=(help) - ^ Riper, Heleen; Kramer, Jeannet; Smit, Filip; Conijn, Barbara; Schippers, Gerard; Cuijpers, Pim (2008-02). "Web-based self-help for problem drinkers: a pragmatic randomized trial". Addiction. 103 (2): 218–227. doi:10.1111/j.1360-0443.2007.02063.x. ISSN 0965-2140.
{{cite journal}}: Check date values in:|date=(help) - ^ Linke, Stuart; McCambridge, Jim; Khadjesari, Zarnie; Wallace, Paul; Murray, Elizabeth (2008). "Development of a Psychologically Enhanced Interactive Online Intervention for Hazardous Drinking". Alcohol and Alcoholism. 43 (6): 669–674. doi:10.1093/alcalc/agn066. ISSN 0735-0414.
- ^ Kypri, Kypros (2008-03-10). "Randomized Controlled Trial of Web-Based Alcohol Screening and Brief Intervention in Primary Care". Archives of Internal Medicine. 168 (5): 530. doi:10.1001/archinternmed.2007.109. ISSN 0003-9926.
- ^ McCarty, Carolyn A.; Whitehouse, Sandy; Spielvogle, Heather; Katzman, Katherine; Richardson, Laura P.; Zieve, Garret G. (2017). "Adolescents' Perspectives on Personalized E-Feedback in the Context of Health Risk Behavior Screening for Primary Care: Qualitative Study". Journal of Medical Internet Research. 19 (7): e261. doi:10.2196/jmir.7474.
{{cite journal}}: CS1 maint: unflagged free DOI (link) - ^ McCarty, Carolyn A.; Taylor, James A.; Spielvogle, Heather; Gersh, Elon; Zhou, Chuan; Richardson, Laura P. (2019-05-03). "Effect of Electronic Screening With Personalized Feedback on Adolescent Health Risk Behaviors in a Primary Care Setting: A Randomized Clinical Trial". JAMA Network Open. 2 (5): e193581–e193581. doi:10.1001/jamanetworkopen.2019.3581.
- ^ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3801194/#R5.
{{cite web}}: Cite has empty unknown parameter:|dead-url=(help); Missing or empty|title=(help) - ^ https://www.reading.k12.ma.us/files/3414/7120/7567/SA3522_sbirt_for_clinicians.pdf.
{{cite web}}: Cite has empty unknown parameter:|dead-url=(help); Missing or empty|title=(help) - ^ "What is SBIRT? – SBIRT". Retrieved 2019-06-21.
- ^ Pringle, Janice L.; Kowalchuk, Alicia; Meyers, Jessica Adams; Seale, J. Paul (2012-03). "Equipping Residents to Address Alcohol and Drug Abuse: The National SBIRT Residency Training Project". Journal of Graduate Medical Education. 4 (1): 58–63. doi:10.4300/jgme-d-11-00019.1. ISSN 1949-8349.
{{cite journal}}: Check date values in:|date=(help) - ^ Thomas, Bied (1993). "Brief interventions for alcohol problems: a review".
{{cite journal}}: Cite journal requires|journal=(help) - ^ "SBIRT: Step by Step Guide" (PDF).
{{cite web}}: Cite has empty unknown parameter:|dead-url=(help)