roject SSERT is a Boston Medical Center Emergency Department Service to facilitate access of patients to primary care, clinical preventive services, and when needed, to the drug and alcohol treatment network. Under its aegis, five culturally competent Health Promotion Advocates (HPA's) function in the Boston Medical Center ED as community-outreach workers. Their role is to detect substance abuse and other preventable conditions, intervene, and refer patients to treatment. The Health Promotion Advocates have been trained to conduct a fifteen minute questionnaire-based interview (the Health Needs History) with all non-critical patients presenting for medical treatment in the ED. This survey of patients' health and safety needs provides the basis for detection of substance abuse and other health needs. Through a brief negotiation interview (BNI) technique, HPA's establish rapport, raise the subject of drugs and alcohol, and assess patients readiness to change.
From April 1, 2002 through March 31, 2004, BMC ED Project ASSERT's HPA's consulted on 6,838 patients referred by the Adult and Pediatric ED and Urgent Care staff. Appointments to BMC Clinics and affiliated Neighborhood Health Centers were given to 1656 patients, 984 of whom did not have a prior primary care physician. Health education brochures were distributed to 1,196 patients, and 334 patients were referred to smoking cessation programs. During this period, 4,703 patients had an acute alcohol or illicit drug problem, and 2,269 were placed in a detox program with transportation provided. There were also 634 referred to outpatient treatment. Unfortunately no beds were available for 656 persons seeking detox, an increase from 7% of patients to 22% of patients compared to the previous year before the cutbacks in treatment beds and funding.
Project Assert was originally funded by CSAT (Center for Substance Abuse Treatment) as a demonstration program in 1993. Project ASSERTís Health Promotion Advocates are dedicated to provide exceptional care without exception, as demonstrated by the City of Boston Management Consortium's Liberty Mutual Customer Service Award in 1996, the Boston Public Health Commissionís Outreach Award in 2002, and the Massachusetts Organization for Addiction Recovery Services Award in 2003.
The RWJ funded Join Together Organization has supported the dissemination of this model to other EDs, and Project ASSERT staff members have provided consultation and hands-on training to their funded projects. Project ASSERT has provided consultation to researchers in the field, and tested its model among cocaine and heroin users in a 5 year randomized trial funded by NIDA. Project Assertís staff also provide mentorship to
and BAHEC students. Recently, as a outgrowth of the Project ASSERT model, the BUMC has received three NIH NIAAA/NIDA grants: Project RAP-Reaching Adolescents for Prevention; Project SAFE to reduce STDs among cocaine and heroin users and an the Academic Emergency Medicine Screening, Brief Intervention and Referral to Treatment, SBIRT, Research Study. City Schools
For more information on BNI/alcohol and drug abuse, call 617/534-4388 and see:
BNI, Brief Negotiation Interview Animation
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