BRief Intervention and Treatment for Elders
Funded by the SAMHSA/Center for Substance Abuse Treatment SBIRT Initiative (2006-2011)
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.
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).
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.
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):
Lakeview Center, Inc. Baptist Hospital Emergency Room, Pensacola
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
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
Florida Hospital Heartland Division Sebring – Emergency Department
Florida Hospital Heartland - Lake Placid
Winter Haven Hospital
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
Coastal Behavioral Healthcare, Inc. (Sarasota area)
Gulf Coast Jewish Family Services
Centre for Women
Drug Abuse Comprehensive Coordinating Office, Inc.
Palm Beach County Division of Senior Services
Hanley Center- Lakeside Hospital
Broward County Elderly and Veterans Services Division (2 sites: BCEVSD Main and BCEVSD North)
Broward County VA Outpatient Center (Miami VA Healthcare System)
Southwest Florida Addiction Services
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:
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: firstname.lastname@example.org
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)
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
In the News:
Information about the
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.
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 email@example.com