BRief Intervention and Treatment for Elders

 

Funded by the SAMHSA/Center for Substance Abuse Treatment SBIRT Initiative (2006-2011)

 

Mission

The mission of the Florida BRITE Project was to serve individuals 55 years and older to identify non-dependent substance use or prescription medication issues and to provide effective service strategies prior to their need for more extensive or specialized substance abuse treatment.

 

The SBIRT Initiative

BRITE implemented the Screening, Brief Intervention, and Referral to Treatment (SBIRT) initiative of the SAMHSA Center for Substance Abuse Treatment (CSAT). Following a three year pilot program funded by the Florida Department of Children and Families Substance Abuse Program Office (DCF/SAPO), in late 2006, Florida was awarded a $14 million CSAT grant to focus on providing services within primary and emergency health care settings, public health clinics, elder homes, and at sites coordinated by aging services. The grant ended on September 14, 2011, but several sites have continued to implement a modified version of the SBIRT model.

 

BRITE clients were offered screening, brief intervention, and brief treatment by these generalist providers or were referred to more intensive care by a substance abuse specialist provider agency. Providers were selected through a competitive process requiring “requests for proposals” submitted to the Florida Department of Children and Families Substance Abuse Program Office (DCF/SAPO).

 

BRITE services were offered in places such as retirement communities, senior centers, general and trauma hospitals, primary care and urgent care clinics, VA medical facilities, and federally qualified health centers (FQHCs).  Since the CSAT grant began, there have been 31 Florida BRITE provider agencies in 18 counties conducting screenings in more than 70 different locations.  By the end of the grant in September 2011, over 91,000 people were screened. Most were adults ages 55 and older (85,001 or 93.3%). The remainder were adults under the age of 55 (6.7%) identified and served by sites in Orlando, Ft. Lauderdale, and Pensacola under separate funding from the Florida Department of Children and Families (beginning in 2010) who were screened at federally qualified health centers (FQHCs).

 

Conference Presentations

Results have been presented at the annual conferences of the Gerontological Society of America, the Florida Conference on Aging, and at the annual SBIRT grantees meetings in Bethesda and Rockville, MD.  A manuscript to be submitted for publication and describing the results is in progress in 2013.

 

Nationally, SBIRT programs typically are located in medical settings such as emergency departments and primary care practices. In many states, all admissions to the medical setting are screened for substance abuse and then given a brief intervention if there are signs of problems that are related to substance use. Duration for a typical session in an E.R. might be no more than 20 minutes, but research indicates substantial reduction in harmful behaviors. Examples of such brief approaches presented as videotaped vignettes can be found at the Boston University Medical Center’s website:  http://www.ed.bmc.org/sbirt/cases.php.

 

The Florida BRITE Project was the first federally funded SBIRT state cooperative agreement grant to focus specifically on the older adult. In addition to medical settings, BRITE health educators screened and provided brief interventions in aging services, retirement communities, senior housing, at health fairs, and at other locations where older adults were likely to congregate or reside. This population is a high priority age-group in Florida, given that Florida has the highest median age population among all states in the U.S.  BRITE has also included a veterans’ initiative with the addition of the Miami Veterans Hospital (Bruce W. Carter Department of Veterans Affairs Medical Center) and the affiliated Broward County VA Clinic. Dr. Robert Hazlett who previously worked in Pennsylvania for that state’s SBIRT grant provided all the training and quality assurance, and developed the educational materials currently used by BRITE.

 

History:  The Pilot Project

The CSAT grant award was built on the success of a three-year pilot project from 2004-2007 funded by DCF/SAPO conducted by Broward County Elderly and Veterans Services, Gulf Coast Jewish Family Services (Pinellas County), Center for Drug Free Living (Orlando), and Coastal Behavioral Health Care (Sarasota). Those four agencies worked closely with aging services and other service providers to screen older adults, often in the elders’ homes. Results from the pilot study of 3,497 screenings were published in the American Journal of Public Health.  That article illustrated statistically significant reductions in use of alcohol, medications, and illicit drugs, as well as reduced symptoms of depression. The provider agencies in that pilot study not only offered in-home screening, but also brief intervention and brief treatment for problems related to alcohol, illicit substances, and prescription and over-the-counter medications. The original four agencies were the first to be part of the five-year CSAT grant and began using the new protocols in January 2007.  Dr. Robert Hazlett, who had previously worked on Pennsylvania’s SBIRT project in the first cohort receiving these CSAT grants, developed the protocols that allowed BRITE to shift from a pilot project to the requirements for the federal grant.

 

Locations

The Florida BRITE Project provider agencies were headquartered in the sites represented by the red stars in the map below. Cumulatively, these agencies screened in more than 70 different locations including hospitals, urgent care centers, trauma centers, aging services, health fairs, and numerous other locations.

 

 

 

Florida BRITE Project Provider Locations

The Florida BRITE Project operated in over 70 different sites under contracts with the following agencies in the Florida Department of Children and Families’ circuits (service areas):

 

 

1st Circuit

Lakeview Center, Inc. Baptist Hospital Emergency Room, Pensacola

 

4thCircuit

 

Urban Jacksonville/Shands Jacksonville Medical Center - Level I Trauma Center

 

Urban Jacksonville Aging Services

 

Shands Jacksonville Level 1 Trauma Center

 

Shands Ambulatory Care Center

 

 

5th Circuit - 2 sites:

 

Lake Regional Urgent Care Center -

 

Lake Regional Urgent Care - Leesburg

 

Lake Regional Urgent Care – The Villages

 

 

9th Circuit

 

The Center For Drug Free Living Inc.  (2 Programs)

BRITE Program in Orange County

BRITE Program in Osceola County

 

Aloma Urgent Care

 

Clermont Walk-In Clinic

       

Longwood Walk-In Clinic

 

10th Circuit

 

Florida Hospital Heartland Division Sebring – Emergency Department

 

Florida Hospital Heartland - Lake Placid

 

Winter Haven Hospital

 

11th Circuit

 

Jackson Memorial Hospital

 

Jackson North Community Mental Health Center

 

Catholic Charities of the Archdiocese of Miami

 

(Miami Veterans Health Care System)

Bruce W. Carter Department of Veterans Affairs Medical Center

 

12th Circuit

 

Coastal Behavioral Healthcare, Inc.  (Sarasota area)

 

13th Circuit

 

Gulf Coast Jewish Family Services

 

Centre for Women

 

Drug Abuse Comprehensive Coordinating Office, Inc.

 

 

15th Circuit

 

Palm Beach County Division of Senior Services

 

Hanley Center- Lakeside Hospital

 

17th Circuit

 

Broward County Elderly and Veterans Services Division  (2 sites:  BCEVSD Main and BCEVSD North)

 

Broward County VA Outpatient Center (Miami VA Healthcare System)

 

20th Circuit

 

Southwest Florida Addiction Services

 

 

 

 

The Florida BRITE Project – Resources

 

The Florida BRITE Project collects prescreening, screening, and assessment data using instruments required by SAMHSA’s Center for Substance Abuse Treatment (the funding source for the project) and educational materials developed by Dr. Hazlett. These are as follows.

 

Required CSAT GPRA Instruments:

  1. Go to SAMHSA’s “Services Accountability Improvement System or “SAIS” at   https://www.samhsa-gpra.samhsa.gov/home/index.htm
  2. At the bottom of the page click on the box that says:  “CSAT-GPRA” this will take you to another webpage.
  3. Click on “GO” and this will take you to the CSAT GPRA page
  4. On the far left side of the page, click on the “Data Collection Tools”
  5. This will open another header “Services” click on that
  6. Select the English or Spanish language instructions for the GPRA assessments as required.

 

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Procedures for Initiating and Sustaining the Florida BRITE Project

Authored by Robert W. Hazlett, Ph.D, CAC, CCS

 

Florida BRITE Project “Business Process Analysis” – This is a guide for BRITE providers to use to obtain information about a clinic or hospital unit’s operating routine. It guides the BRITE team’s effort to design a protocol to implement BRITE in a specific setting, while being sensitive to the workflow and logistical support issues of that particular setting.

 

Florida BRITE Project “Initial Training Manual” – this manual provides training to site personnel for screening of potential substance use, abuse and dependence disorders in a hospital, primary care or clinic setting and how to apply brief intervention strategies matched to the patient’s severity of use/abuse of alcohol and other drugs (AOD).

 

Florida BRITE Project “Sustainability Manual” – This is a guide to understanding what is involved in the process of developing a sustainability plan for SBIRT services even after federal grant funding ends. It is a framework that allows for flexibility and change in your agency’s local environment, and that considers elements that may impact that environment.

 

Assessment Instruments and Educational Materials for BRITE

Some materials are in the public domain and available from CSAT and other selected instruments developed for BRITE can be accessed by emailing Dr. Robert Hazlett:   robert_hazlett@dcf.state.fl.us

 

Screening Instruments

 

  • Short Geriatric Depression Scale (S-GDS) – Administer if the person responds “YES” to either of the two prescreening items on depression.

 

 

  • Required instruments available from CSAT or the World Health Organization (WHO0 -  Florida BRITE Providers may download the following items from either the respective websites:

 

Educational Materials

  • Handouts to be distributed to professionals and clients of the BRITE Project are available in both English and Spanish.

 

 

 

 

 

 

 

 

  • Curricula
    • Brief Intervention:

1.    BRITE Health Promotion Workbook (English)

2.    BRITE Health Promotion Workbook (Spanish)

3.    Brief Intervention for Problematic Use:  Guidelines for Use in Primary Care (from World Health Organization)

 

    • Brief Treatment:

Substance Abuse Relapse Prevention for Older Adults (from SAMHA/CSAT 2005). Order hard copies from SAMHSA’s clearinghouse by at NCADI website: http://ncadistore.samhsa.gov/catalog/productDetails.aspx?ProductID=17179

 

  • Supplemental Materials for Brief Intervention and Brief Treatment

 

 

 

 

 

 

 

 

 

 

 

 

 

In the News:  Information about the Florida BRITE Project

 

OLDER AMERICANS BEHAVIORAL HEALTH Issue Brief: Series Overview - The Substance Abuse and Mental Health Services Administration (SAMHSA) and U.S. Administration on Aging (AoA) partnered to develop this 2012 Issue Brief to address behavioral health issues for older Americans. SAMHSA and AoA included BRITE in its listing of evidence-based and evidence-informed programs and practices for older adult behavioral health. These programs have been scientifically studied and have been shown to improve the health and functioning of older adults.

 

Elder screening finds "hidden" substance misuse. Reuters Health News June 6, 2012.

 

 

For information about BRITE, please contact:

 

Larry Schonfeld, Ph.D., Professor and Interim Executive Director, Florida Mental Health Institute, University of South Florida, Tampa, FL 33612

Phone:  (813) 974-1946 or email schonfel@usf.edu