Alcohol screening, brief intervention, and referral to treatment (SBIRT) programs are time-limited, patient-centered counseling sessions that significantly reduce alcohol consumption and alcohol-related injuries. In 2006, the American College of Surgeons Committee on Trauma (ACS/COT) mandated SBIRTs in verified Level I trauma centers. However, there has been little effort to translate research on these programs into best practices for implementation. The purpose of this research was to describe the process and important components of SBIRT adoption and implementation in trauma centers that implemented before versus after the ACS/COT mandate. Three qualitative case studies were conducted at Level I Adult/Pediatric trauma centers. Key informant interviews with program staff and a review of selected documents regarding SBIRT implementation were the primary sources of data for this study. This research concluded that the adoption process was important regardless of the presence of the ACS/COT mandate, especially for raising awareness among trauma center staff of patients' unhealthy alcohol use. Concerns about patient privacy and insurance reimbursement were commonly cited as issues that slowed the implementation process. Comparisons among trauma centers implementing before versus after the ACS/COT mandate showed differences as expected on the reason for adoption, the level of program adaptation, and the meaning of the program among trauma staff. Social ties to other trauma centers did not play a large role in implementation. Across trauma centers, having a program champion, a dedicated and experienced interventionist delivering the program, staff buy-in, and the capacity for monitoring, evaluation, and patient follow-up post-discharge were identified as core components of implementation. A comprehensive framework was developed to illustrate the process, differences, and important and core components of SBIRT adoption and implementation in trauma centers. This study investigated a current phenomenon that has important consequences for the future use of SBIRTs, a needed and effective behavior change intervention that reduces the risk of alcohol-related injuries. Answers to the research questions posed and the resulting comprehensive framework may begin to bridge the gap between research and practice by guiding future implementation research and assisting trauma centers in program implementation and refinement.
|School:||The Johns Hopkins University|
|School Location:||United States -- Maryland|
|Source:||DAI-B 70/04, Dissertation Abstracts International|
|Subjects:||Public health, Health care management|
|Keywords:||Alcohol screening, Medical referrals, Substance abuse, Treatment programs|
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