1. Enter your access code:                  

 
This is a six character alphanumeric code that you used to enter data in step 1. You must enter the same access code, otherwise your responses will not be linked together. If you have forgotten the code, please start with a new code and re-enter your data under this new code. 

2. Enter your organization code:

 
Data will be collected across each organization within your operations.  Organization refers to an institution with an independent budget and board of directors.  You selected the organization code in a previous survey. 

3. Select the component of SBIRT which was part of your service?  (Repeat this survey for each component) 

Screening Brief Intervention Referral (case management) Brief Treatment

4. Who typically delivered the service?

Physician
Nurse practitioner
Masters prepared social worker
Substance abuse counselor
Other or combination of clinicians.  Please specify which clinicians were involved:

5. Where was the service typically delivered?

Primary care office
Emergency department
Substance abuse treatment program
Community center
Other or combination of settings.  Please specify the setting:

6. Describe the nature of this component.  Do not exceed 350 characters, including spaces.  Start with the phrase "... is defined to be ...".  Here are sample definitions for various components:

Screening is defined using distinct valid brief questionnaires (Alcohol Use Disorder Identification Test, Drug Abuse Screening Test and the Alcohol, Smoking and Substance Involvement Screening Test) about the context, frequency and amount of alcohol or other drug used by an individual.

Brief interventions use time-limited, self-help and preventive strategies to promote reductions in the case of nondependent clients, and in the case of dependent clients to facilitate their referral to specialized treatment programs. The primary goal of brief interventions is to increase motivation for behavior change.

Brief treatment is defined to include Cognitive Behavioral Treatment and Motivational Enhancement Therapy over several sessions to identify antecedents and consequences of use, develop coping skills, and prevent relapse.

 

7. What was the maximum duration of this service for 95% of your clients (please ignore the 5% of your clients who required longer screening or brief intervention)?   

For example, if the screening or the brief intervention is part of an existing clinic visit and not a distinct separate component, you would enter 0 additional time.  So asking whether the client smokes may be considered a 0 additional minute but conducting a comprehensive substance use assessment may be considered 30 additional minutes. 

For another example, a brief intervention that takes almost most of the time of the visit will be considered a visit beyond general visit. 

Alternatively, please look at a worksheet for estimating the time spent on screening, brief intervention and other components click here.

  additional minutes per visit

8. What was the maximum number of times that a client received this service during the year (please ignore the 5% of clients who used this service the most)?

  times per person

  To Survey of Costs & Census