Massachusetts ACEP, ENA, Nurse Practitioners, Medical Interpreters
Association, Boston EMS, and the Massachusetts Hospital Association
Massachusetts Organization for Addiction Recovery

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The Program

Step 1: The site selection process

Interested EDs submitted a one page letter of intent and a two page application (see link in the column to the left). In this application, each site
1) estimated the number of ED patients with alcohol and other substance abuse problems, and identify their unmet needs;
2) described the impact of substance abuse on ED flow and patient care quality;
3) explained current practices and policies for screening and referral;
4) listed areas for improvement;
5) shared your strategy to motivate your ED team to improve care;
6) rated the likelihood of institutional support for a new program;
7) suggested substance abuse treatment system and community resources that might collaborate with your ED;
8) identified particular prevention issues you might like to include in this program;
9) described unique characteristics of your setting that should be addressed in this new program. 

Site selection occurred in October of 2006. The selection committee consisted of representatives from the Bureau of Substance Abuse Services and other interested state agencies, the Institute at Boston University, and representatives from sponsoring ED provider organizations.

Step 2: local leadership team and training in Boston
Each site has selected a multi-disciplinary ED leadership team (representing physicians, nurses, social workers, EMTs, and interpreters) . Each team came to Boston Medical Center for a two day didactic and experiential training to strategize together and come up with best methods to address specific site needs and anticipated barriers to introducing SBIRT, and improve quality of care for patients with substance abuse problems.

Step 3: Educate providers, using an evidence-based ED training curriculum 
BNI-ART Institute educators have developed a standardized curriculum for ED providers -- an SBIRT ‘road show’--  to bring to each local site.  We will hold a series of 2 hour workshops (a combination of didactic, interactive, and role play techniques) across shifts and clinical disciplines. These meetings will include ED staff, primary care providers at neighborhood health centers, and treatment providers from the local area.

Step 4: Hire two peer educator for each ED
Job descriptions for a new, health promotion based ED peer educator position are beingdeveloped at each site, advertised, and individuals hired and trained, both didactically and experientially at Boston Medical Center. Technical assistance and consultation will be provided by the Institute as the health promotion advocates establish their new role.

Step 5: Evaluate and sustain
At each site, meetings are being held with individuals who will be key to implementation: hospital administration, local IT experts with knowledge of the administrative database, billing personnel, human resources staff, ED administrators. An Access® data base form for direct data entry, already tested in a variety of locations around the country, will be completed for each patient encounter at the time of service. Patients who provide consent will be followed by telephone.  CPT codes for screening and brief intervention are currently being developed by Medicare and Medicaid CSM and should be available within the year. The Institute will work with each site to establish systems for billing that will make this program sustainable.