Screening, Brief Intervention, and Referral to Treatment with a Trauma Module

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The Substance Abuse and Mental Health Services Administration is accepting grant applications for fiscal year (FY) 2011 that build upon SAMHSA�s Screening Brief Intervention and Referral to Treatment (SBIRT) for alcohol and illicit drugs and that test the additive value of integrating a screening and brief intervention module for trauma. The established SBIRT approach for substance use has been successful in identifying and intervening with asymptomatic, risky substance users in primary care. The purpose of the program is to implement SBIRT in primary care settings; and to develop and test new trauma modules for integration into SBIRT. Findings from this program will determine the feasibility of integrating trauma screening and brief intervention with the established SBIRT and the additive value to individuals and primary care providers.This initiative supports SAMHSA�s Strategic Initiatives for Trauma and Justice and Prevention of Mental Illness and Substance Abuse. For more information about psychological trauma, see SAMHSA�s website at http://www.samhsa.gov/traumaJustice and http://www.samhsa.gov/prevention.SBIRT has been defined and practiced at SAMHSA as a comprehensive, integrated, public health approach to the screening and identification of individuals who are practicing risky alcohol and drug use, and the timely delivery of early brief interventions to these people in order to reduce risky use which, if not successful, leads to their timely referral to more intensive substance abuse interventions. In addition to these integral components to the program initiative, SAMHSA defines SBIRT as a model with the following objectives:It is brief (typically about 5-10 minutes for brief intervention; about 5-12 minutes for brief treatment)Screening is universalOne or more behaviors targeted to risky alcohol and drug use are targetedThe services are delivered in a public health non-substance abuse treatment settingIt is comprehensive (comprised of screening and referral to brief intervention and/or treatment)Research, evaluation, or experiential evidence is gathered to assess the model�s effectivenessThe SAMHSA definition of SBIRT is based on methodology that was developed during the implementation of a comprehensive SBIRT grant program comprised of each of the model components cited above, and supported by research by the National Institute on Alcohol Abuse and Alcoholism, and the National Institute on Drug Abuse. Similar to risky substance use, trauma exposure is found at a high rate of prevalence in primary care and, like risky substance use, often goes undetected and untreated. The Adverse Childhood Experiences study documented the relation between childhood exposure to trauma and prevalence of chronic physical and behavioral diseases in adulthood, and revealed a high prevalence of trauma exposure among people receiving treatment in primary care settings. Trauma screening and interventions within primary care settings, therefore, may improve outcomes for these individuals and prevent long-term physical and behavioral consequences. Past SAMHSA grant awards have been successful in implementing SBIRT for alcohol and substance use in primary care settings. This RFA builds on SAMHSA�s existing SBIRT program by developing and testing the additive value of integrating trauma components with previously established traditional SBIRT implementations.Trauma is a widespread, harmful, and costly public health problem. It occurs as a result of violence, abuse, neglect, loss, disaster, war, and other emotionally harmful experiences. Trauma has no boundaries with regard to age, gender, socioeconomic status, race, ethnicity, geography, or sexual orientation. It is an almost universal experience of people receiving treatment for mental and substance use disorders. The need to address trauma is increasingly viewed as an important component of effective behavioral health service delivery.Although many people who experience traumatic events will go on with their lives without lasting negative effects, others will have more difficulty and experience traumatic stress reactions. Emerging research has documented the relationship among traumatic events, impaired neurodevelopmental and immune system responses, and subsequent health risk behaviors resulting in chronic physical and behavioral disorders. With appropriate supports and intervention, people can overcome traumatic experiences. However, most people go without these services and supports. Unaddressed trauma significantly increases the risk of mental and substance use disorders, chronic physical diseases, and early death. The intent of the current grant program is to use SBIRT as a platform to identify trauma exposures and the potential for traumatic responses before they occur and interfere with health and behavioral health.SBIRT-TM grants are authorized under Section 509 of the Public Health Service Act, as amended. This announcement addresses Healthy People 2020 Mental Health and Mental Disorders Topic Area HP 2020-MHMD and Substance Abuse Topic Area HP 2020-SA.

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