SBIRT SCREENINGS: Results for July 2013-February 2014
Overview
The modified SBIRT tool screens for mental health issues in the past two weeks (using the GAD-7 and PHQ-9), substance abuse problems (using the AUDIT-10 and DAST 28), domestic violence exposure in the past year (PVS-3), and exposure to trauma in the past year (PCL-C).[1]
Between July 1, 2013 and February 28, 2014, a total of 4,296 patients were seen at the UCI clinic. Of those, 4,256 patients (99%) were screened using the modified SBIRT. The remaining 40 patients were not screened because of language barriers or special needs. During that same time period, 1,226 patients were re-screened (29%).
The graph below shows the number of patients screened each month, and the monthly number who were re-screened. Over time, the number of patients who were re-screened has steadily increased, with 40% or more of all screenings in the last 3 months being with patients who were previously screened.
Of the 4,256 patients who were screened, two-thirds (67%) were women and one-third were men. The majority of patients who were screened were aged 50 or older (60%), whereas 34% were aged 26-49 years, and 6% were 18-25 years old.[2]
Positive Screens
A total of 1,186 out of the 4,256 patients (28%) screened positive for a mental health, substance abuse, domestic violence, and/or trauma issue.
The majority of positive screens were for mental health problems (86%), while 9% of positive screens were for substance abuse problems, and 5% were for domestic violence issues (see graph). Only 3 cases of trauma have been identified thus far.[3]
During the first 8 months of the project, 106 patients screened positive for two or more issues, indicating that nearly 9% of all positive screens were for co-occurring issues. This accounts for 2.5% of all patients screened during the study period.
· Two-thirds of the co-occurring screens were positive for mental health and substance abuse problems, and one-third showed mental health and domestic violence co-occurrence. There were no co-occurrences identified for domestic violence and substance abuse.
Notably, over half (54%) of the positive screens identified an “untreated” issue (i.e., an issue that had not been treated/addressed in the previous month).
Positive Screens: By Age and Gender
Slightly more women than men screened positive using the modified SBIRT. In fact, 23% of men (326 of 1,393) and 30% of women (860 of 2,863) who were screened using the modified SBIRT screened positive for a mental health, substance abuse, domestic violence, and/or trauma issue.
Moreover, the modified SBIRT identified a greater proportion of positive screens for younger and middle-aged patients than for older patients. Specifically, while 22% of patients aged 50 or older screened positive, 34% of patients aged 26-49 years and 30% of patients aged 18-25 years screened positive for a mental health, substance abuse, domestic violence, and/or trauma issue.
Referrals/Linkages
A total of 1,203 referrals were made for the 1,186 patients who screened positive for one or more issues. The majority of referrals (81%) were to community services, whereas 10% were referred to County mental health services (AMHS) and 8% were linked to County substance abuse services (ADAS). Additionally, 10 clients (1%) were linked with the County’s Crisis Assessment Team (CAT).
Referrals were made for an additional 258 patients who screened negative but who were considered “at risk” for having a mental health, substance abuse, domestic violence, or trauma issue. Of these individuals, 226 were linked with community services and 32 were linked with County services.
Re-Screens/Follow-Ups
Patients who visited the clinic multiple times were screened using the modified SBIRT at each visit. With each screening, patients’ screening status was coded as either positive or negative (i.e., they screened positive or negative for a mental health, substance abuse, domestic violence, and/or trauma issue). Follow-up screening status (i.e., positive or negative) was compared with prior screening status (i.e., positive or negative) for each patient. The results in this section are based on data available from November 2013 through February 2014.[4]
More than half of patients (57%) who were screened and re-screened showed no issues at initial or follow-up screenings. In contrast, 16% showed persistent issues (i.e., they had a positive screen at both initial and follow-up screenings), and another 8% had a worsening of issues (i.e., they had a positive screen at follow-up after screening negative at an earlier visit). Nearly one-fifth (18%) of patients showed an improvement in symptoms (i.e., they had a positive screen initially, but re-screened as having no mental health, substance abuse, domestic violence, or trauma issues at follow-up).
Between November and February, we also tracked whether patients followed up on referrals that were made at a previous visit. Only 21% of patients followed up on referrals that were made, while 79% did not. Reasons for not following up with referrals will be tracked more carefully in the future.
Summary
Ninety-nine percent (99%) of all patients visiting the UCI Clinic in Santa Ana between July 2013 and February 2014 were screened using a modified SBIRT, with an average of more than 500 patients screened each month. Patients were re-screened if they visited the clinic more than once.
More than one in four patients screened positive for a mental health, substance abuse, domestic violence, and/or trauma issue, with more than 8 out of 10 of those patients screening positive for mental health issues. Additionally, nearly 1 in 10 screened positive for substance abuse problems and 1 in 20 screened positive for domestic violence issues.
Over half of all positive screens identified an “untreated” issue (i.e., an issue that had not been treated/addressed in the previous month).
Overall, 2.5% of all patients screened showed positive signs of co-occurring problems, most commonly for co-occurring mental health and substance abuse disorders.
Women were slightly more likely than men to screen positive using the modified SBIRT, and younger and middle-aged patients were more likely to screen positive than patients 50 and older.
Over 1,200 referrals were made for patients who screened positive for one or more issues, with over 80% being referred to community services, and smaller numbers being referred to County mental health, substance abuse, and crisis services.
Among patients who were screened more than once, more than half showed no issues at initial or follow-up screenings, and nearly 1 in 5 patients who were re-screened showed an improvement in symptoms over time. In contrast, 16% showed persistent problems and 8% showed a worsening of issues (i.e., they had a positive screen at follow-up after screening negative at an earlier visit).
Notably, only 21% of patients followed up on referrals that were made, while 79% did not. It is unclear whether patients who showed improvement over time were the same patients who followed up on referrals, as data are tracked on an aggregate level. Reasons for not following up with referrals will be tracked more carefully in the future and attempts will be made to track the screening status of individuals who follow up on referrals with those who do not.
Prepared by Health Policy & Communication – Planning & ResearchPage 1
[1] GAD-7=Generalized Anxiety Disorder (7 items); PHQ-9=Patient Health Questionnaire ( 9 items); AUDIT-10= Alcohol Use Disorders Identification Test (10 items); DAST 28=Drug Abuse Screening Test (28 items); PVS-3= Partner Violence Screen (3 items);PCL-C=PTSD Checklist – Civilian version.
[2] Age demographics are based on patients screened between November and February, because we only began tracking gender in November.
[3] The trauma question was added to the screening tool in November, 2013.
[4] In November, we started tracking the “no change” categories (i.e., positive to positive, negative to negative screen) as two separate categories, because one indicates persistent symptoms (two positive screens) and the other indicates no symptoms at either assessment (two negative screens).