Posted: May 1st, 2025

Data collection Method and instruments

The purpose of this assessment is to explain the data collection methods and instruments for your project as well as analyze the data to determine the extent to which you have achieved desired project outcomes. You will be using the feedback from this assessment to revise related portions of your Doctoral Project Report in your next course. Be sure to retain your feedback and plan for the needed revisions.

As you collect data for your project, take care not to deviate from your IRB-approved plan. You may not change your data collection methods without IRB approval. Discuss any data collection issues you are experiencing with your faculty facilitator.

Similarly, it is imperative that you follow your IRB-approved doctoral project proposal/research plan as you collect your data. Failure to do so is considered noncompliance and may result in sanctions; typically, the IRB will not let you use any data collected.

Data collection and analysis are critical to evaluate project-related outcomes accurately. For this assessment, you will describe your approach to data collection and analyze the data to determine the extent to which project outcomes have been achieved. Note that the results of your analysis may not indicate the achievement of outcomes or could prove inconclusive. You are only responsible for analyzing the data impartially and communicating the results.

For this assessment you will complete the Download Data Analysis Template [DOCX].

This template will help you structure your report on your data collection methodology and data analysis, including instruments used and outcomes achieved. You are not expected to submit your raw data for this assessment; however, you should store your raw data securely so you can provide it if necessary.

Your assessment will be graded on the following criteria:

Analyze project data and present the outcomes of the interventions, findings, and recommendations related to the problem statement using appropriate writing and graphics.

Communicate in a clear, concise, and well-organized manner, using tone and vocabulary appropriate for a professional and scholarly report.

Data Collection Instruments: Be sure to reference any instruments used in this assessment via citation (external items) or inclusion in an appendix (internal items).By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:

Competency 2: Collect data specific to valid and reliable outcomes.

Explain IRB-approved data collection methods for the doctoral project.
• Competency 3: Draft the data analysis.

Explain the design of the doctoral project.

• Analyze project data and present intervention outcomes, findings, and recommendations related to the problem statement using appropriate writing and graphics.
• Competency 6: Address assessment purpose in a well organized text, incorporating appropriate evidence and tone in grammatically sound sentences.

Apply APA formatting and style throughout, with special attention paid to data charts, figures, and tables.

Write clearly and concisely in a logically coherent and appropriate form and style.

Project Data Analysis – Secondary Review Scoring Guide

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Data Analysis
Your Full Name (no credentials)
Capella University
Course Number and Name
Instructor Name
Month, Day, Year
2
Introductory content before any Level 1 headings. It might be useful to provide some
brief background information on your project and its context. This section is a summary of your
project as it will be added to your final paper. This information should only be two or three
paragraphs at most.
Design and Instrumentation
Explain the project design and the methods you used for collecting data. The methods
you describe must be reliable and have been previously approved by the IRB. If you used any
tools or instruments, explain their validity and reliability, citing support from the literature as
relevant. If an external tool was used, note the permission to use the tool and cite the tool
appropriately. Any internal tools proven valid and reliable should be submitted in an appendix.
Formative Evaluation (if applicable)
Confounding Variables (if applicable)
Analysis
Explain which statistical tests were used for the statistical analysis to determine if the
selected intervention produced the outcome desired. Provide outcomes, findings, and
recommendations related to the problem statement. If you are still collecting data, you may have
enough data to report preliminary findings; if this is the case, please note which findings are
preliminary. For outcomes for which you have insufficient data to draw findings, please note this
under each relevant outcome and briefly explain findings that would indicate some degree of
outcome achievement. You may wish to use Level 2 headings to separate your analysis for each
outcome, the problem statement, and so on. Use charts, data tables, and figures as relevant to
improve the communication and comprehension of your data. Even if you do not have all final
data collected, you should still be able to draft appropriate charts, data tables, and/or figures that
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would appropriately report the data you have collected or are planning to collect for a given
outcome.
Summary and Conclusion
Briefly synthesize the key conclusions from the data analysis. Note any additional data
collection and analysis to take place this quarter or additional analyses you plan to undertake.
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References
[List references here.]
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Appendices
Doctoral Project Implementation Plan
Name:
Organization: Banyan Health System
Date: 02/02/2024
Project Title: Enhancing Medication-Assisted Treatment (MAT) Referral Rates through the Implementation of Alcohol Screening,
Brief Intervention, and Referral to Treatment (SBIRT) Tools
PICO or PICO(D) Question
For the community mental health center providers (P), how does the required per-visit implementation of the Alcohol
Screening, Brief Intervention, and Referral to Treatment (SBIRT) tools (I) compared to current practice (C) affect the referral rate to
Medication-Assisted-Treatment (MAT) program (O) over 12 weeks (T)?
Project Description
Many people who have substance use disorders do not access the help they need in treatment and recovery from addiction. As
identified in the literature, one of the main barriers to accessing treatment is a gap in the care continuum whereby patients at the
primary care level are not assessed for and referred for substance use services (Jones et al., 2023). This project seeks to close that gap,
specifically in Miami. Banyan Health System is a healthcare organization comprising several clinics across Miami-Dade and Broward
County providing mental health services. The aim of this project to be implemented in the health system is to educate staff on alcohol
screening, brief intervention, and referral to treatment (SBIRT) and implement referral protocols to enable patients with diagnosed or
suspected alcohol use disorder (AUD) to access medication-assisted treatment (MAT) services. The project primarily seeks to enhance
MAT access for people attending at Banyan Health System through screening and referrals.
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This project addresses patients with comorbid mental health disorders and AUD for referral for appropriate AUD treatment.
SBIRT is an evidence-based approach for identifying people who use alcohol and other drugs with risky use behaviors or addiction
(Babor et al., 2023). It helps identify people needing assistance to prevent adverse outcomes of addiction and other health and safety
problems. This project will introduce and institute SBIRT at Banyan Health System to effectively identify those at risk of AUD. MAT
is also an evidence-based approach whereby medications are combined with counseling and therapy to assist an individual in beating
problematic drug use and addiction (Richard et al., 2020). This project will use SBIRT as a channel to enhance access to MAT for
people with AUD.
This project will include staff training, provision of resources, and ongoing quality improvement to enable access to MAT.
After training and resource provision, all patients will be assessed and receive appropriate AUD intervention. Typically, all patients
presenting at the health system will undergo a brief alcohol use screening to determine whether they use alcohol or not and, if they do,
the amounts and frequency. Following SBIRT procedures, the healthcare professional attending them will determine the level of risk.
They (the provider) will then implement brief intervention as needed and referral if required for those deemed needing further
treatment. The project will create a practice norm and protocol for SBIRT to connect patients with the needed AUD resources and
services.
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Data Evaluation and
Person/Area
Measurement(s)
Responsible(s)
Objective(s)
Key Action Step(s)
Expected Outcome(s)
Provide SBIRT
1. Assess the current
There will be a
Pre- and post-intervention
Director of
and MAT training
knowledge and
statistically significant
tests: Staff knowledge will be
Employee
to all staff at
utilization of SBIRT
increase in staff
assessed before training,
Development and
Banyan Health
among providers.
knowledge on SBIRT
immediately after, and two
Compliance
Systems who
2. Organize and develop
and MAT
weeks after training to
assess and provide
training materials and
determine any change in
treatment services
workshop.
knowledge (Jacobsen, 2020)
to patients.
3. Conduct actual
training with staff at
each Banyan Health
location.
4. Assess post-training
knowledge and
competence using
SBIRT
Integrate SBIRT
into clinical
workflow
1. Analyze current
clinical workflows.
All staff will report
Surveys with staff: Post-
Chief medical
routinely using the
integration surveys will be
officer
conducted to determine
whether staff have integrated
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Objective(s)
Data Evaluation and
Person/Area
Measurement(s)
Responsible(s)
Key Action Step(s)
Expected Outcome(s)
2. Identify and plan
SBIRT process in their
the practice into their clinical
clinical assessments
workflow (Jacobsen, 2020)
At least 90% of all
Records review: All SBIRT
appropriate integration
of SBIRT in the
clinical workflow.
3. Hands-on staff training
on new workflow.
4. Monitor
implementation
Establish SBIRT
1. Stakeholder meeting
and referral policy
on appropriate SBIRT
patients attended in the
screening and assessments
and guidelines for
practices
health system will be
will be documented in patient
assessed using SBIRT
records. The implementation
staff
2. Policy drafting and
review by stakeholders
team will review all patient
for any revisions or
records and identify
updates.
documented SBIRT
3. Disseminate complete
policy statement and
Team leader
interventions (Thoele et al.,
2021)
guidelines to all staff
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Objective(s)
Key Action Step(s)
Expected Outcome(s)
Monitor change
1. Identify appropriate
The implementation
and implement
feedback mechanisms
team will hold meetings
continuous quality
for the project.
every three months and
improvement
2. Develop project
(CQI) process
ongoing review
with the
schedule and
implemented
processes.
SBIRT changes
implement
Data Evaluation and
Person/Area
Measurement(s)
Responsible(s)
Review CQI processes and
Quality
interventions annually through Improvement
a retrospective review of
Specialist
documentation
improvements as needed
3. Test CQI pilot in one
Banyan Health System
clinic and review.
4. Revise CQI processes
and activities as
needed.
5. Roll out CQI program
in the entire health
system
Determine factors
affecting SBIRT
1. Review staff
adherence to the
Staff will relate the
Interviews: Post-
experience of
implementation, staff will be
Team leader
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Objective(s)
Key Action Step(s)
Expected Outcome(s)
Data Evaluation and
Person/Area
Measurement(s)
Responsible(s)
and MAT
SBIRT protocols and
implementing change
interviewed to explain their
adherence at
guideline.
and outline facilitators
experience with the change
and barriers to change
process and factors affecting it
implementation
(Jacobsen, 2020)
Banyan Health
System
2. Interview staff on the
implementation
process including
enablers, barriers, and
challenges
experienced
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LOGIC MODEL
Project Title: Enhancing Medication-Assisted Treatment (MAT) Referral Rates through the Implementation of Alcohol Screening,
Brief Intervention, and Referral to Treatment (SBIRT) Tools
Problem the Project Will Address: Patients served by Banyan Health System have inadequate access to medication-assisted
treatment (MAT) for alcohol use disorder
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Inputs
Program
Participants
• The project team
involved in planning,
training,
implementing, CQI,
and evaluation
• Staff in the health
system who will
implement SBIRT
and MAT referral
Activities
Staff training on
SBIRT and MAT
• Evaluate all providers
•
Training & CQI
Resources
•
•
Training materials
such as brochures, IT
resources, and charts
Access to referral
locations
Time
Time spent in preparing,
training staff, and
evaluating the program
•
on their SBIRT
knowledge
Facilitate workshop and
training sessions
Policy and guidelines
development
•
Outputs
•
Develop a written
policy statement on
SBIRT integration into
clinical workflow and
guidelines for
implementation
• Review the policy with
staff to determine
feasibility and changes
Stakeholder and team
meetings
•
Regular meetings will
be held to plan change,
•
Outcomes
Short-term
Routine SBIRT
implementation with
all patients- All
patients attended at
Banyan will be
screened and
engaged in the
SBIRT process
Staff knowledge on
SBIRT and MATImproved
knowledge and
competence in
implementing
SBIRT interventions
and referring
patients to MAT
Referrals to MATResources for MAT
to be provided to
patients who need
them
• Counseling &
treatment servicesServices directly
•
•
•
Patients- Improved
access to MAT
services
Providers &
healthcare systemImproved
competence &
knowledge in
SBIRT, improved
clinical workflows
Community- Better
responsiveness to
healthcare and
addiction services
Medium-term
•
•
Patients- More
patients will access
MAT services and
engage in
rehabilitation
services
Providers &
healthcare systemRoutine SBIRT with
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implement, and review
progress of the program
Clinical workflow
review
•
The chief medical
officer will lead the
team in reviewing
current clinical
workflow and planning
changes that will be
needed to integrate
SBIRT
provided at Banyan
centers by
healthcare providers
•
Long-term
•
Project review and
evaluation
•
•
Data collection before
and after project
implementation to
determine effectiveness
of the change
Team meetings to
facilitate CQI and
evaluate progress
at least 90%
compliance
Community- More
people will seek
AUD treatment
services in the
community treatment
centers
•
•
Patients- Sustained
recovery from AUD,
improved physical
and mental health,
and fewer adverse
events
Providers &
healthcare systemRecognition and
reputation as reliable
in SBIRT & MAT
CommunityReduced rates of
untreated AUD and
other substance use
disorders, better
mental health
outcomes
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References
Babor, T. F., McRee, B. G., Kassebaum, P. A., Grimaldi, P. L., Ahmed, K., & Bray, J. (2023). Screening, Brief Intervention, and
Referral to Treatment (SBIRT): Toward a public health approach to the management of substance abuse. Alcohol/Drug
Screening and Brief Intervention, pp. 7–30.
Jacobsen, K. H. (2020). Introduction to health research methods: A practical guide. Jones & Bartlett Publishers.
Jones, C. M., Han, B., Baldwin, G. T., Einstein, E. B., & Compton, W. M. (2023). Use of medication for opioid use disorder among
adults with past-year opioid use disorder in the US, 2021. JAMA Network Open, 6(8), e2327488-e2327488.
https://doi.org/10.1001/jamanetworkopen.2023.27488
Richard, E. L., Schalkoff, C. A., Piscalko, H. M., Brook, D. L., Sibley, A. L., Lancaster, K. E., & Go, V. F. (2020). “You are not clean
until you’re not on anything”: Perceptions of medication-assisted treatment in rural Appalachia. International Journal of Drug
Policy, 85, 102704. https://doi.org/10.1016/j.drugpo.2020.102704
Thoele, K., Moffat, L., Konicek, S., Lam-Chi, M., Newkirk, E., Fulton, J., & Newhouse, R. (2021). Strategies to promote the
implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) in healthcare settings: A scoping
review. Substance Abuse Treatment, Prevention, and Policy, 16(1), 42. https://doi.org/10.1186/s13011-021-00380-z
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Routine Alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT) to
Enhance Referral to Medication-Assisted-Treatment (MAT): Literature Review
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Routine Alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT) to
Enhance Referral to Medication-Assisted-Treatment (MAT): Literature Review
Access to medication-assisted treatment (MAT) for people with substance use disorders
is crucial for them to overcome addiction and prevent overdose. The proposed project seeks to
integrate alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT) into usual
care in a community mental health center. The aim of implementing SBIRT is to enhance
referrals to MAT services for people with Alcohol Use Disorder (AUD) and those at risk of
dependence and other adverse outcomes. This systematic review presents an overview of current
evidence on integrating SBIRT in mental health care routine assessment to promote referrals to
MAT.
Search Strategy
A thorough literature review is indispensable for academic endeavors such as journal
articles, theses, dissertations, and working papers. Conducting a literature search aids in
identifying research gaps and potential avenues for further exploration. This process facilitates
the acquisition of pertinent information on a subject matter, thereby pinpointing areas requiring
additional investigation (Chigbu et al., 2023).
The objective of the current search was to locate articles relevant to the PICOT question:
“For community mental health center providers, how does the mandatory per-visit
implementation of Alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT)
tools compare to current practice in affecting the referral rate to Medication-Assisted-Treatment
(MAT) programs over 12 weeks?” This inquiry centers on routine SBIRT implementation in a
community clinic and its potential to facilitate referrals to MAT for individuals with substance
use disorders.
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The search encompassed databases like PubMed, Google Scholar, and Web of Science,
alongside open Internet searches and scrutiny of selected articles’ references. These databases are
well-suited for nursing research and offer access to a vast repository of articles pertinent to the
PICOT question. Academic search engines like Google Scholar have been lauded for their userfriendly interface, enhancing accessibility to scholarly resources even for non-specialists
(Gusenbauer & Haddaway, 2020).
Keywords derived from the PICOT question and related searches, such as SBIRT,
screening, brief intervention, and medication-assisted treatment, were utilized to refine the
search. A specified search algorithm was employed, and parameters were set to include articles
published within the last five years (2020-2024), available in English, and offering full-text
accessibility. After selecting relevant articles, their references were reviewed, employing a
snowballing approach to access further studies specific to the PICOT question.
Inclusion criteria for the selected articles comprised publication within the specified
timeframe, availability of full text, publication in English, and focus on SBIRT or similar
screening methodologies in healthcare settings addressing substance use risks and disorders.
The search produced 72 studies (20 on PubMed, 32 on Google Scholar, 15 on Web of
Science, and 5 on open Internet search). After excluding duplicate records, 51 articles were
considered for eligibility assessment. The final articles meeting the criteria and included in the
synthesis were 30 after excluding based on the inclusion criteria above.
Each selected article was scrutinized for relevance to the PICOT question, synthesizing
the main themes and findings outlined in MS Excel tables. Most of the articles are related to
screening for alcohol or opioid use disorders in diverse settings, including community and
medical centers. While some systematic reviews and guidelines were included, most studies were
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interventional projects evaluating the efficacy or feasibility of screening and MAT treatment
options in various contexts.
Overall, the search yielded credible evidence on SBIRT and community-based MAT,
highlighting their effectiveness in promoting access to resources for substance use disorder
treatment, albeit with identified barriers and facilitators. Variability in interventions and contexts
across studies underscores the complexity of addressing substance use disorders
comprehensively.
Substance Abuse and Alcohol Use Disorder Background
Alcohol and substance abuse are affecting millions of Americans. The development of
substance use disorder (SUD) and risky alcohol use behaviors presents severe consequences to
the safety, health, and social relationships of the affected person. Addressing substance use
disorder is a priority for public health professionals, and an advanced practice nurse must
understand the trends, patterns, and associated factors to appreciate the severity of the issue and
address it appropriately.
Alcohol Use Disorder (AUD) and problematic alcohol use patterns are common in
Miami, and the associated complications justify screening for early identification and referral to
treatment. Many adults and adolescents drink alcohol, and a significant proportion of those who
drink regularly have developed an alcohol use disorder. According to the National Survey on
Drug Use and Health (NSDUH), 172.7 million adults (around 67.4%) regularly drink alcohol
(US Department of Health and Human Services [HHS], 2023). 16.7% of youths aged between 12
and 17 also drink alcohol (HHS, 2023). Limited and responsible drinking in adulthood is often
recommended for people who take alcoholic drinks. However, a significant population has
developed an alcohol use disorder (AUD). In the United States, around 28 million adults (11.2%)
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and 753,000 young people aged 12-17 years (2.9%) have AUD (HHS, 2023). AUD can generally
be defined as a condition in which an individual struggles to stop or control alcohol use despite
experiencing adverse consequences in one or more areas of life. The numbers outlined here show
that many people struggle with AUD and need medical and psychosocial assistance.
Specific to Miami, Florida, AUD, and problematic alcohol use are also alarming. In
Miami-Dade County, 17% of young people in middle and high school used alcohol in the past 30
days, and 8% reported binge drinking (Florida Department of Children and Families, 2020). 18%
of adults in the state engage in binge drinking, and between 2012 and 2019, the number of deaths
in which alcohol was identified as a contributing factor increased from 4,029 to 5,385 (HHS,
2023). In Miami-Dade County, problematic alcohol use, binge drinking, and AUD are common
problems affecting millions of people of all ages, and these problems present a public health
challenge for healthcare professionals.
Alcohol is one of the most used drugs, and although it may be deemed harmless, it has
serious health consequences. The Centers for Disease Control and Prevention (CDC, 2022)
recommends avoiding alcohol or ensuring moderation in drinking: no more than one drink for
women or two drinks for men per day. Short-term effects of alcohol include changes in
perception, hearing, and vision, as well as loss of coordination, all of which can lead to injury. In
the long term, alcohol abuse may cause inflammation of the pancreas and alcohol-related liver
disease (National Institute on Alcohol Abuse and Alcoholism [NIAAA], 2021). Gastrointestinal
ulceration, hypertension and cardiovascular events, lower libido, and increased risk of cancer are
other health complications from problematic or long-term alcohol use (NIAAA, 2021).
Therefore, it is essential to regulate alcohol consumption to minimize adverse health
consequences.
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Problematic alcohol use and AUD can be identified, and proper treatment can commence
with regular screening in healthcare facilities. Advanced practice nurses are responsible for
preventive healthcare and should implement screening. Brief screening for problematic alcohol
use in primary care and outpatient visits can help identify problems early, connect the patient to
the relevant treatment and assistance resources, and prevent complications associated with
alcohol. The above mentioned statistics on problematic alcohol use and AUD in Miami and
nationally indicate that a significant proportion of the community is affected by this substance
use disorder. Early identification and access to treatment options can prevent complications and
promote patients’ health.
Universal Screening
Universal screening is the idea of normalizing alcohol and substance use questions and
has been developed alongside the idea of SBIRT. In universal screening, lead-up questions are
included in the standard patient interview during intake, and further screening is conducted if the
patient has a positive outcome in the lead-up questions (Knox et al., 2019). For instance, the
nurse conducting intake may ask a simple question: Do you take alcohol or any other drugs? This
may be closely followed by the type of drug and frequency of the amount taken (Hays et al.,
2020). These seemingly simple questions pave the way for the examiner to assess any problems
or risks in the patient. For instance, if a patient states that they take alcohol every day, the
examiner can then conduct a more detailed evaluation to determine the amount and associated
risks, such as signs of addiction (Hays et al., 2020).
The theme of universal screening has been discussed and tested by various researchers.
The importance of universal screening, according to Moberg and Platzer (2021), is normalizing
questions about alcohol and substance use in the healthcare setting. By normalizing these
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questions, the providers encourage openness in discussing alcohol and substance use patterns and
conducting brief interventions when necessary. De la Cruz et al. (2021) detail that the standard
measures for universal screening should be self-reports in the waiting room, mainly using the
intake questionnaire. This approach works by not only introducing the topic but also helping the
patient open regarding any problematic drug use they may present with (de la Cruz et al., 2021).
The impact of universal screening on the identification of substance use disorders and
referral to MAT has been documented. Moberg and Platzer (2021) conducted an initiative to
promote screening among Medicaid beneficiaries in a community health center. Their
implementation of universal screening was associated with higher odds of being diagnosed with
a mental health disorder, alcohol use disorder, and other drug dependence (Moberg & Platzer,
2021). Similarly, Berkman and Soto-Silva (2022) conducted a DNP project for universal
screening and reported increased rates of SBIRT implementation and referral to treatment. In
both studies, implementing universal screening in community health centers increased rates of
alcohol and other substance use disorder diagnoses as well as the rates of referring patients to
treatment (Berkman & Soto-Silva, 2022; Moberg & Platzer, 2021). These findings outline the
importance of universal screening in enhancing the diagnosis of alcohol and substance use
disorders as well as referral to treatment.
Various factors must be considered for effective universal screening and integration of
SBIRT. Gertner et al. (2021) integrated peer support specialists (PSS) in the emergency
department for universal screening, which increased access to Buprenorphine. PSSs are
healthcare professionals with a background in health counseling and substance use rehabilitation
who are integrated into the interprofessional team in the ED. They provide the appropriate
guidance and support for people with SUD risks (Gertner et al., 2021). Monico et al. (2020)
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demonstrated that scaling up SBIRT in all emergency departments and primary care units can
also help identify people with problematic alcohol and substance use trends. Elsewhere, Kamath
et al. (2022) showed that telehealth-delivered screening services could also be used to promote
universal screening, and this intervention was conducted during the COVID-19 pandemic.
Integrating PSS, scaling up SBIRT, and telehealth are all feasible and practical approaches to
implementing universal screening.
Several resources and strategies are needed to implement universal screening. First, staff
in the emergency department must be trained in the initial universal screening step. This includes
asking questions regarding alcohol use and other substance use and establishing whether patients
present with a risk of problematic substance use (Kamath et al., 2022). This training includes
providing these healthcare professionals who are the initial contact with the patient with the tools
used for screening (Hammock et al., 2020). In addition to staff training, healthcare professionals
must also have brief intervention and referral skills. These nurses or physicians conduct the
patient assessment, take notes, and begin the treatment process (Thoele et al., 2021). Brief
intervention usually involves some form of counseling and providing the patient with advice
regarding problematic alcohol or substance use trends. Referral is only initiated if the patient’s
has severe use or dependence on alcohol or drug. Training professionals must use screening tools
effectively, categorize the patient’s use behaviors, and adequately implement the brief
intervention and referral as needed (Hammock et al., 2020).
In addition to training on SBIRT, cultural competence is essential when implementing
universal screening. In their update for the US Preventive Service Task Force regarding
screening for unhealthy drug use, Patnode et al. (2020) recommended using culturally competent
approaches to screen patients for problematic alcohol and drug use. According to Campbell et al.
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(2020), cultural competence is the recognition of the different cultural backgrounds of patients
encountered and approaching these differences with sensitivity and respect. Recognizing
language differences and beliefs and using polite, sensitive, and nonjudgmental language for the
patients are essential approaches to ensuring cultural competence (Patnode et al., 2020).
Universal screening means that everyone showing up to the healthcare facility undergoes initial
screening for problematic alcohol and substance abuse (Gertner et al., 2021). Culturally
competent approaches are necessary to ensure that the screening is effective and responsive to
diverse patient needs and characteristics.
Facilitators to Screening
Establishing universal screening assist SBIRT to be the norm in healthcare facilities.
However, for universal screening to be implemented successfully and consistently, certain
conditions and facilitators have been identified in the literature as essential. In general,
facilitators are the factors that enable and support healthcare professionals in effectively
implementing SBIRT. They range from personal characteristics such as competencies to
organizational and industry factors such as training and support provided by the healthcare
organization.
Leadership and organizational policy are the most critical facilitators in implementing
SBIRT universal screening. A physician champion as the leader in SBIRT and universal
screening was identified as an essential approach and technique to promoting buy-in and
commitment (Evans et al., 2023). Other than having a physician champion, having site
coordinators (local champions) has also been identified as essential in ensuring effective and
consistent implementation of SBIRT (Keen et al., 2021). Local champions are very similar to
physician champions, with the only difference being that local champions could be nurses or
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other healthcare professionals (Keen et al., 2021). In addition to champion leaders, running a
universal screening program has been portrayed as requiring systems leadership as the essential
approach (Christie, 2021). Systems leadership is a leadership approach that recognizes the
complex interrelationships among the different systems in the healthcare organization. The
systems leader will ensure effective coordination of SBIRT components, and the presence of
resources as needed (Christie, 2021). There is a high degree of agreement in the literature
regarding the role of leadership in implementing universal screening and SBIRT, which indicates
the importance of the approach in facilitating implementation.
Besides leadership, Evans et al. (2023) have identified the need for supportive policy to
facilitate change implementation. In their discussion, they have identified the need for policy
reforms to be implemented in the healthcare organization for the new policy to be adopted.
Similarly, Christie (2021) identified the need for a policy to ensure permanence and consistency
in implementing SBIRT and universal screening. As discussed, the policy’s role is to empower
staff and leaders to understand and gain the support they need for the ongoing implementation of
universal screening (Hammock et al., 2020; Evans et al., 2023; Christie, 2021). Specific policies
and regulations, including policy reforms, in healthcare organizations facilitate universal
screening by providing appropriate support and guidance for change implementers.
Recent research has increasingly focused on the role of buy-in and training in facilitating
change in healthcare organizations. Christie (2021) reviewed facilitators and barriers and
identified staff buy-in as the most crucial to implementing SBIRT. A problem many healthcare
organizations face is the lack of consistency and compliance from healthcare professionals
(Kamath et al., 2022). In attaining buy-in, providing adequate training and communication on the
change is essential. Staff understanding of the SBIRT process, inclusion in the change
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implementation, and access to information and resources are all important in promoting their
buy-in (Evans et al., 2023). Buy-in can also be promoted through ongoing training and
facilitation of the latest updates in universal screening and SBIRT (Christie, 2021). The literature
has highlighted organizational buy-in as gaining the support and willpower of staff and leaders
involved in the change. It is a facilitator, especially in ensuring the sustainability of the long-term
implementation of SBIRT changes.
The specific practices in the SBIRT universal screening process have also been identified
as determining staff and patient’s use of the process and its effectiveness. The skills of the staff in
implementing SBIRT are essential in determining the effectiveness of the process (Fisher et al.,
2024). For instance, staff members should have adequate training and competence in using the
screening tool. In addition to knowledge and competence, Karno et al. (2021) identified the
importance of a ‘warm hand-off’ with others in treatment sites. A warm hand-off means that the
staff members handing off patients must exchange details in person and in the patient’s presence
to capture all the required information (Fisher et al., 2024; Karno et al., 2021). This helps in
obtaining information and achieving the appropriate orientation that the patient needs to
transition from one healthcare system to another. Another vital practice identified is the
providers’ follow-up after referral. The standard approach to SBIRT referral is that the provider
will make a call to the institution fitting the patient’s needs and arrange for transfer or intake of
the patient (Christie, 2021). However, further determining whether the patient showed up for
treatment and their progress facilitates the referral process (Fisher et al., 2024). The overarching
purpose of referral is to facilitate access to care, and this can be enhanced by conducting followup to determine that the patient obtained the help they needed.
12
Many researchers agree that interdisciplinary support and customizing interventions to
organizational context can enhance SBIRT and other screening interventions (Keen et al., 2021;
Hammock et al., 2020; Karno et al., 2021; Christie, 2021). Substance use and abuse is an
interdisciplinary issue mainly because of the complex needs that patients may have. For instance,
they may experience homelessness, have medical comorbidities, and other issues such as
nutritional status (Hammock et al., 2020). Keen et al. (2021) found that organizations
implementing an interdisciplinary collaborative approach are more effective in implementing
SBIRT than others. Additionally, it is crucial to recognize the unique cultures of different
workplaces. Therefore, when implementing a universal screening routine, it is necessary to
evaluate the organizational culture and context (Keen et al., 2021). The intervention has to be
tailored to organizational norms and context to promote buy-in and support implementation.
The facilitators to implementing SBIRT and universal screening are generally the
conditions that enable implementers to adopt the screening approaches effectively. In summary,
the main facilitators are having buy-in and facilitating training, good leadership, communication,
supportive policy, interdisciplinary support, and implementing changes based on the
organizational context. The main challenge identified is the sustainability of such interventions
(Christie, 2021). However, implementing the change while focusing on the abovementioned
facilitators can help address these challenges appropriately.
Main Barriers to Implementation
Despite efforts to implement SBIRT and universal screening, healthcare professionals
often face many barriers in implementing the practice. One of the most common barriers is the
shortage of time and staffing resources to implement adequate screening for all patients (Christie,
2021; Fisher et al., 2024; Konkle-Parker et al., 2023). Many healthcare organizations in the US
13
face staffing shortages, meaning physicians and nurses have minimal time with their patients,
often less than five minutes. This creates time pressure and prevents adequate alcohol and
substance screening (Konkle-Parker et al., 2023). Konkle-Parker et al. (2023) have identified the
healthcare professionals’ attention to detail as associated with time pressures. For instance, there
may be hints of alcoholism and problematic substance use. Because the provider is focused more
on the medical issues and lacks time for holistic assessment, they may overlook such problems
(Konkle-Parker et al., 2023). Many emergency departments, especially in major hospitals, are
often overcrowded and lack adequate staff to attend to the large patient population (Gertner et
al., 2021). The lack of adequate resources, specifically staffing, is an essential barrier to
implementing SBIRT and universal screening for problematic alcohol and substance use.
Moreover, integrating screening into the existing workflow is another challenge and a
barrier affecting many professionals’ implementation of SBIRT and other screening forms.
Integration into the workflow is a challenge, mainly due to the disruptions that universal or
routine screening may bring (as cited in Christie, 2021). This occurs when implementing change
and interrupting the status quo or norm implemented by healthcare professionals. Austin et al.
(2023) found that most healthcare staff who failed to comply with SBIRT implementation
changes mentioned disruptions in their workflow as a leading reason for noncompliance. In
another study, participants identified the lack of integration processes as causing disruptions in
the workflow (Konkle-Parker et al., 2023). From these studies, it appears that for effective
implementation, it is essential to integrate the screening process to fit well with the workflow to
enhance buy-in and compliance from healthcare professionals.
Another barrier identified in many studies is the lack of staff training or complex
screening tools. Implementing a universal screening policy requires adequate staff training to
14
ensure that their skills and competencies can facilitate change (Fisher et al., 2024). Also, training
enhances their readiness for change by identifying their specific roles and responsibilities in the
workplace. This training should include aspects such as an easy-to-use screening tool. SBIRT is
generally easy to implement with the right tools (Hammock et al., 2020). However, Austin et al.
(2023) have identified using complex and challenging tools as a significant challenge in
implementing universal screening. When staff struggle to understand and use the tool effectively,
the screening process becomes ineffective. Staff training should be hands-on, but in the
experience of many implementers, inadequate preparation and training of nurses to implement
the universal screening and SBIRT interventions lead to poor implementation processes (Gertner
et al., 2021). Barriers such as training and screening tools indicate the healthcare organization’s
lack of readiness and commitment to the transition process.
Besides staff training and screening tools, care coordination barriers have also been
identified as necessary in SBIRT and universal screening. Care coordination is organizing
healthcare resources to ensure patients access care where and when needed (Konkle-Parker et al.,
2024). SBIRT requires care coordination, especially in referral and access to treatment. The
research by Hammock et al. (2020) identified that many participants lacked access to and
coordination of care as needed. In another study by Berkman and Soto-Silva (2022), healthcare
professionals and organizations experienced reimbursement challenges; hence, the entire care
coordination process was severely challenged. From these studies, the care coordination process
is mainly challenged due to a lack of a policy to support it and an effective reimbursement
process to support it (Berkman & Soto-Silva, 2022; Hammock et al., 2020). Therefore, the lack
of policy for care coordination and reimbursement comes across as an essential barrier, as
captured in the literature.
15
The barriers to implementation have generally been classified as individual and systemsbased barriers. Individual barriers, personal capacity, beliefs, and compliance with regulations
and policies have been highlighted (Austin et al., 2023; Fisher et al., 2024). In the systems-based
barriers, training, communication, implementation policies, resources, and care coordination
have been highlighted (Konkle-Parker et al., 2024; Berkman & Soto-Silva, 2022). While
individual barriers can be handled at the staff level, the systems barriers must be handled at the
systems level, focusing on the interventions and policies that can facilitate universal screening
and SBIRT. The current literature has highlighted these as some of the most common barriers,
but many others exist at the organizational context level. Therefore, research at the
organizational and individual levels is needed to promote an understanding of implementation
issues specific to the implementation context.
Access to Alcohol and Substance Abuse Treatment
The purpose of SBIRT is to ensure timely access to the required help for people with
alcohol and substance use disorders. Access to alcohol and substance use treatment is, therefore,
an essential determinant of the success of SBIRT. Healthcare professionals could implement
SBIRT, but its practicality and success largely depend on access and availability of resources
needed. Research has focused on this significant determinant of success in alcohol and substance
use disorder treatment. Therefore, this section outlines findings on current access, the impact of
screening on access, and models tested to enhance access to this treatment.
Research has indicated that although access to medication-assisted treatment is
increasing, it is barely adequate for those who need it. Abraham et al. (2020) reviewed the
literature on current trends and access to MAT. They reported that less than 20% of specialty
treatment centers in the US offered any single medication for alcohol use disorder, and only
16
around 40% offered medications for opioid use disorders (Abraham et al., 2020). Elsewhere,
Gertner (2020) conducted a review of current practices. Like Abraham et al. (2020), they relied
on existing literature to establish the current rates of access to alcohol and substance use disorder
MAT. Their research determined that within the states, many government departments encourage
the adoption and distribution of Buprenorphine by non-specialists (Gertner, 2020). However,
concerns regarding training on treatment and appropriate use of the medications limit access
(Gertner, 2020). Therefore, despite efforts to increase access to MAT, the current literature has
identified that access is suboptimal and could be improved.
Several researchers have evaluated the impact of SBIRT and universal screening and
referral on access to MAT. Sullivan et al. (2021) conducted a retrospective chart review of the
impact of universal screening and referral using bridge clinics. Between January 2017 and
December 2018, the intervention indicated success in increasing access to MET through prompt
referral to the emergency department (Sullivan et al., 2021). The project was also associated with
increased Buprenorphine treatment adherence. Similarly, Bogan et al. (2020) implemented a
quality improvement project like Sullivan et al. (2021). In this intervention, they implemented
Buprenorphine initiation in the emergency department and provided additional referrals as
needed. Similar to the previous study, Bogan et al. (2020) found that the intervention increased
access to MAT in a rural Southern state. These two studies are similar in their methodology
(quality improvement), and their findings are similar, too. The findings suggest that interventions
to enhance screening and timely referral and interventions work to enhance access to MAT for
alcohol and other substances.
Various researchers have also implemented models for improving access to MAT.
Gertner (2020) focused on efforts in North Carolina to improve MAT for Medicaid beneficiaries.
17
Their report found that Medicaid expansion in the state was an effective model for enhancing
access to MAT. They also abolished fears that increased access to MAT due to Medicaid
expansion was coming at a cost to the quality of healthcare (Gertner, 2020). Samuels et al.
(2021) focused on Rhode Island, specifically on a program implemented in the state to enhance
access to MAT. The Levels of Care program was the first state-based standard for MAT,
focusing on defining and designating facilities based on the level of care and MAT provided in
those facilities (Samuels et al., 2021). The program was associated with an increase in access to
MAT and the availability of MAT treatments for Medicaid services (Samuels et al., 2021).
Similarly, Whiteside et al. (2022) implemented a model for ED-initiated Buprenorphine
called Project ED Health. The common aspect of the three models discussed here is the
availability of training and medications at the ED and access within a short period (Whiteside et
al., 2022; Samuels et al., 2021; Gertner, 2020). Therefore, these studies suggest that enhancing
MAT access requires focusing on accessibility by the public and the efficacy of providing
treatment regardless of the patient’s location.
Addressing Stigma
Stigma is one of the most common barriers to alcohol and substance use treatment, and in
this paper, it has been discussed separately from the barrier’s subtopic. The rationale for this
differentiation is that stigma is a widespread phenomenon affecting providers and patients. On
the side of providers, stigma may affect how they conduct SBIRT and other universal screening
approaches and treatments. It affects their willingness to coordinate care and availability of
medications and services needed. On the part of patients, stigma may affect their willingness to
seek help and care for alcohol and substance use disorders (Austin et al., 2023). Therefore, this
18
last section of the literature review focuses on current research on stigma and how to address it
while implementing SBIRT.
Stigma has been identified as a significant barrier to accessing and using alcohol and
other substance use treatment resources. Austin et al. (2023) identified that stigma deterred
people with problematic use trends and substance use disorders from seeking treatment in
healthcare centers. Their research is based on previous research in a systematic literature review.
Similarly, Gomez et al. (2023) also found that stigma towards substance use disorders deterred
patients from seeking care. Specifically, stigma was rooted in the belief that substance use
disorders were a choice rather than a chronic medical condition (Gomez et al., 2023).
Concerning MAT, stigma has also been associated with low adherence and use of the treatment
approaches. Richard et al. (2020) conducted semi-structured interviews in Appalachian
communities. They found that stigma was associated with poor use of MAT because people
believed that MAT could create dependence and sustain abuse. They reported that stigmatization
remains one of the crucial barriers to screening and timely MAT implementation.
Despite the challenges of stigmatization and its impact on access to care, SBIRT has been
identified as potentially effective in addressing this stigma. Evans et al. (2023) found that
implementing SBIRT ‘normalized’ screening for SUD de-stigmatized the process, especially
among healthcare providers. Similarly, Austin et al. (2023) reported that integrating routine
screening in healthcare visits was associated with reduced stigma toward screening for and
treating SUDs. Gomez et al. (2023) found that training nurse students and nurses in SBIRT can
reduce the stigmatization of patients with substance use disorders. The improvement was
observed primarily among students but less so in practitioners. From this research, training
19
healthcare professionals in SBIRT and its implementation in healthcare facilities may reduce
stigma and enhance access to and utilization of healthcare resources.
Some research has also been conducted on the use of motivational interviewing as a
means of encouraging screening and take up of treatment. Bielenberg et al. (2021) conducted a
systematic review of literature. Among other findings, the researchers established that
motivational interviewing and communication interventions were associated with increased
acceptance of SUD treatment. Buckner et al. (2021) and Scott et al. (2023) also found that
motivational interviewing was effective in enhancing motivation for treatment. This intervention
addressed stigma by familiarizing the patient with treatment and normalizing discussions on
SUD and the appropriate treatment (Bielenberg et al., 2021; Buckner et al., 2021; Scott et al.,
2023).
Conclusion
Current literature has outlined the importance of SBIRT and referral to MAT treatment
for alcohol and other drug use disorders. The main themes identified in the literature include
universal screening, facilitators and barriers, access to substance use treatment, and
stigmatization. All these themes have been identified in current literature, and the research
identifies the role of SBIRT and other universal screening methods in enhancing access to care.
Findings from current literature suggest that implementing routine SBIRT and referral to MAT
for alcohol use disorder can enhance health outcomes and reduce addiction and dependence in
the community health center.
20
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1
Quality/Performance Improvement Framework
January, 2024
2
Quality/Performance Improvement Framework
Alcohol use disorder (AUD) is a common substance use problem affecting many people in
the community. Screening for AUD and provision of the necessary treatment can help reduce the
adverse effects of addiction on the people and the community at large. Among patients who are at
risk of or present with symptoms of potential substance use disorder diagnosis, prompt screening,
intervention, and referral to primary health centers are recommended (Uong et al., 2021). The
identified problem at Banyan Health Systems is that there is no adequate screening and referral to
treatment for AUD. As a result of this low screening, there are also low rates of referrals for
medication-assisted treatment (MAT) programs for those who can benefit from them. This project
seeks to improve AUD screening and referral to MAT at Banyan Health Systems.
Current Practice Needing Improvement
Inadequate screening and referral are the main problems of focus. The leading causes of
this practice need and gap are inadequate referral procedures, insufficient training and awareness,
inadequate resources, and lack of policies. An effective referral process and procedures should
support the screening and referral process. Such procedures at Banyan Health Systems have led to
low screening and referral. The staff at the healthcare organization also have not received training
on Screening, Brief Intervention, and Referral to Treatment (SBIRT). This lack of awareness and
buy-in has led to underutilization of the process. This project also needs resources, specifically
technology for data collection and MAT program resources. Lack of adequate MAT resources is
one of the common causes of its failure (Babor et al., 2023). The last cause is the lack of policies
and recognition procedures. There are no policies to support routine AUD screening, and there is
no program to recognize those who consistently use the SBIRT.
3
Overall, the gap in the project is the lack of a clear and structured SBIRT program for AUD
and MAT referral programs. The desired ideal situation is that all patients who present with
substance use disorder (SUD) risks are screened for alcohol use and dependence. The SBIRT
program includes referrals, and if the evidence indicates a referral for further intervention, nurses
and providers at Banyan Health Systems should be able to refer immediately. However, there is
currently no policy or protocol for screening using the SBIRT tool, and healthcare providers are
not trained at Banyan Health Systems. The gap, therefore, is the lack of resources, training, and
support to implement the evidence-based approach to alcohol use disorder screening, intervention,
and referral.
QI/QP Framework
The quality improvement and planning framework to be used in this project will be the
Plan-Do-Study-Act (PDSA) framework. This is a systematic approach to conducting numerous
cycles of continuous improvement to achieve reflective practice and improvement in quality. The
implementers plan a change, apply a small change, and then study it to determine whether it can be
effective in a larger context and implement incrementally more significant changes (Moser et al.,
2020). This evidence-based approach supports iterations, step-wise improvements, and incremental
improvements in quality of care. Therefore, it will be appropriate and will support the quality
improvement program at Banyan Health Systems.
Using the PDSA framework, several interventions are needed to achieve the desired
outcomes and objectives. The first one is training staff on SBIRT. This training will focus on
increasing the competence of healthcare providers in the organization to ensure effective
implementation of screening, brief intervention, and referrals specific to AUD. Secondly,
guidelines and policies to support implementation will be developed. Guidelines and policies help
4
standardize healthcare interventions and adopt new practices (Babor et al., 2023). Therefore, there
is a need to create a set of guidelines that healthcare providers can use when implementing SBIRT
and a policy defining the required practice changes. The third component is the provision of
resources and support for staff implementing the change.
Additionally, formative assessments will be conducted to ensure that the project is on
course. These assessments will include an assessment of staff knowledge and competence in
implementing SBIRT. After training, staff will be assessed to determine whether they have gained
the competence necessary for implementation. Also, staff must document the SBIRT process with
all patients assessed. A weekly review of records to determine rates of SBIRT use and referrals will
be conducted. This will facilitate weekly formative assessments of the processes and facilitate
numerous PDSA cycles.
Data Collection and Analysis
The data to be collected will include program implementation data and satisfaction and
perceptions data. MAT referral rates are the essential data to be collected. This data will determine
whether the program improvement has increased SBIRT referrals to MAT programs. Additionally,
provider knowledge and competence in AUD screening will be assessed using Likert scales preand post-training. Patient compliance, referral timeliness, provider satisfaction, and patient
satisfaction data will also be collected. Compliance and timeliness data will be collected via health
records reviews, and the rest of the data will be collected using surveys with the respective
participants. These types of data will allow for a detailed program analysis.
The analysis process will include pre-and post-intervention analyses as well as descriptive
data. Basic statistics such as averages, median, and standard deviations are recorded in descriptive
data analysis. These will be used to analyze satisfaction levels, compliance, and timeliness. In
5
comparing pre- and post-intervention data, student t-tests will be used (Jacobsen, 2020). Data on
providers’ perceptions of challenges will also be collected using interviews. These will be recorded
and transcribed, and thematic analysis will be used to identify common challenges and themes.
QI/PI Changes and Expected Outcomes
The changes needed for this program are the implementation of the SBIRT process with
patients suspected of problematic alcohol use and referring them for MAT. This process can be
integrated into everyday practices at healthcare facilities. To achieve this outcome, staff will
engage in brief screening questions by simply asking the patient whether or not they drink alcohol
and the frequency and amount taken. If a patient presents a positive score, the SBIRT process will
be initiated with appropriate intervention and referral to MAT. If staff regularly and consistently
conduct prescreening and follow-up with patients suspected of problematic use, this will indicate
actual improvement.
The change is highly feasible because it is not radical and practical in the primary care
setting, even in community clinics such as Banyan Health Systems. The staff needs to know the
questions to ask when conducting the patient assessment as part of the patient assessment
interview. They then need knowledge for brief intervention, such as guidance and education on
appropriate alcohol limits and referrals for patients who need additional care. This program’s main
determinants of success are the staff’s willingness and competence to carry out the screening, brief
intervention, and referral. It does not require complex technical skills, only knowledge of
problematic alcohol use and information on available referral resources in the community (Moser
et al., 2020). Therefore, it is expected that this program will be implemented successfully, and its
success will be seen in the consistent use of SBIRT and MAT referrals for AUD in the health
system.
6
Evaluation of Changes in Quality and Performance
The changes in quality and performance will be evaluated through ongoing monitoring of
referral rates and feedback and surveys with the involved stakeholders. Referrals and interventions
will be recorded in the organization’s health records and can be accessed at any moment in the
program implementation. Statistical analysis of trends in referral rates will be the primary method
of evaluating changes and performance improvement. Additionally, staff and patients are
encouraged to provide feedback on their experiences and perspectives regarding the project. This
feedback and regular surveys to be conducted every two months will be used to determine
performance and quality improvement. The criteria for evaluation are increasing rates of referrals
and positive experiences in the project. The number of patients referred to MAT for AUD should
increase with time to indicate that the project is successful. The feedback from stakeholders and
responses to the surveys should also be positive. Ongoing monitoring and evaluation will form the
basis for determining change effectiveness and performance improvement.
Conclusion
The proposed project will improve MAT referrals for AUD at Banyan Health Systems by
training staff in SBIRT and providing support for the implementation. This project is meant to
improve referrals to treatment and access to care for AUD among locals served by the health
systems. The expected outcomes are that staff in the health facilities will routinely assess patients
using alcohol use screening questions and advance the SBIRT steps as necessary. This evidencebased intervention will generally connect people with AUD to the care they need via their local
healthcare facility.
7
References
Babor, T. F., McRee, B. G., Kassebaum, P. A., Grimaldi, P. L., Ahmed, K., & Bray, J. (2023).
Screening, Brief Intervention, and Referral to Treatment (SBIRT): Toward a public health
approach to the management of substance abuse. Alcohol/Drug Screening and Brief
Intervention, pp. 7–30.
Jacobsen, K. H. (2020). Introduction to health research methods: A practical guide. Jones &
Bartlett Publishers.
Moser, T., Edwards, J., Pryor, F., Manson, L., & Hare, C. (2020). Workflow Improvement and the
Use of PDSA Cycles: An Exploration Using Screening, Brief Intervention, and Referral to
Treatment (SBIRT) Integration. Quality Management in Health Care, 29(2), 100–108.
https://doi.org/10.1097/QMH.0000000000000245
Uong, S., Tomedi, L. E., Gloppen, K. M., Stahre, M., Hindman, P., Goodson, V. N., Crandall, C.,
Sklar, D., & Brewer, R. D. (2021). Screening for excessive alcohol consumption in
emergency departments: a nationwide assessment of emergency department physicians.
Journal of Public Health Management and Practice, 28(1), E162–E169.
https://doi.org/10.1097/phh.0000000000001286
Project Charter
1
Project Charter
Part 1
Project Charter Information
Project Name
Enhancing Medication-Assisted Treatment (MAT) Referral Rates through the Implementation of
Alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT) Tools
Project Site
The project site is at Banyan Health System, a community mental health center in Miami, Florida.
Contact at site
Name with credentials
Organizational Email: Phone Number: (
Name with credentials: :
Preceptor
Email:
Phone Number: (
The Executive Sponsor for this project holds the position of Chief Medical Officer and Senior
Vice President at Banyan Health System. This individual was selected for their significant role in
Executive Sponsor
overseeing and guiding the medical aspects of the organization. As a key decision-maker and leader
within the healthcare system, their involvement ensures alignment with organizational goals and
enhances the project’s credibility and support.
2
The current practice at Banyan Health System reveals a gap in addressing alcohol misuse among
individuals seeking mental health services. Currently, there is no established process for promptly
screening and referring patients to the Medication-Assisted Treatment (MAT) program, particularly
for co-occurring substance use disorders, notably alcohol misuse. The absence of a streamlined
protocol for screening and referral exacerbates the difficulty in connecting individuals with the MAT
program promptly.
Identifying this gap stems from an in-depth analysis of national and internal data. Nationally,
studies such as those by Babor et al. (2023) and Karno et al. (2021) emphasize the importance of
Screening, Brief Intervention, and Referral to Treatment (SBIRT) tools in addressing substance abuse.
Internally, data from Banyan Health System indicates a suboptimal referral rate to the MAT program,
Gap Analysis
signifying a clear need for improvement.
The desired condition involves implementing routine Alcohol Screening, Brief Intervention, and
Referral to Treatment (SBIRT) tools into standard care protocols. This proactive approach aims to
enhance the identification and referral of individuals with alcohol-related concerns to the MAT
program, ultimately improving patient outcomes.
The Gap Analysis tool employed for this project is the Fishbone diagram, which visually
represents the cause-and-effect relationships contributing to the identified gap. The Fishbone diagram
provides a comprehensive overview of the various factors influencing the current state and aids in
developing targeted interventions for improvement. The appendix includes the detailed Fishbone
diagram for reference (Appendix 1).
3
The proposed project is grounded in a compelling need to address barriers hindering individuals
with co-occurring substance use and mental health disorders from accessing optimal treatment.
Substantiating this need, Agterberg et al. (2020) delve into the examination of treatment barriers with
a focus on gender differences. The study sheds light on the challenges faced by women, revealing
higher barriers related to family responsibilities, relational factors, and mental health when compared
to men. These findings emphasize the unique obstacles encountered by women seeking substance use
treatment, providing a clear rationale for the development of gender-responsive services (Agterberg et
al., 2020).
Recent research underscores the significant prevalence and impact of Alcohol Use Disorders
Evidence to Support the
Need
(AUDs) on individual health and public healthcare systems. Yeo et al. (2022) reported in “JAMA
Network” a notable increase in alcohol use, related disorders, and a rise in mortality rates among
younger individuals, especially in the context of the COVID-19 pandemic. Concurrently, the
effectiveness of Medication-Assisted Treatment (MAT) in treating AUDs has been increasingly
recognized. Arms and colleagues (2022) conducted a comprehensive review, highlighting MAT’s
efficacy in reducing alcohol-related harm and relapse rates. Despite MAT’s proven effectiveness, the
utilization remains limited. Snell-Rood et al. (2021) identified barriers such as lack of awareness,
stigma, and insufficient referral rates in “The Psychiatric Service Journal.”
In the past decade, there has been a 16% increase in alcohol use and a 58% increase in high-risk
drinking among women. High-risk drinking is defined as consuming more than three drinks in a day
or more than seven drinks in a week. This trend is particularly concerning due to the unique and
severe consequences for women. Women experience a faster progression to alcohol-related problems
4
and alcohol use disorders (AUD) compared to men. Pregnant women risk exposing the fetus to
alcohol. SBIRT is a public health strategy to address risky alcohol use in women. The article provides
guidance for healthcare providers on best practices for preventing and treating alcohol-related risks in
women of all ages (Hammock et al., 2020).
The role of Screening, Brief Intervention, and Referral to Treatment (SBIRT) in enhancing MAT
referrals is gaining attention. Thoele et al. (2021) demonstrated that SBIRT implementation in primary
care settings significantly increases MAT referrals. Further, integrating SBIRT into routine healthcare
practices has been shown to streamline the identification of individuals with AUDs and their referral
to MAT. Babor et al. (2023) suggested that healthcare systems incorporating SBIRT experienced
higher rates of successful MAT referrals. Lastly, the cost-effectiveness and societal benefits of SBIRT
implementation are notable. Green et al. (2022) in “Health Economics” found that every dollar spent
on SBIRT implementation yielded significant returns regarding reduced healthcare costs and
improved societal outcomes, emphasizing these interventions’ economic and social value.
A study by Uong et al., (2021) evaluated the screening practices for excessive alcohol
consumption among emergency department (ED) physicians. The study found that out of the 347
surveyed ED physicians, only about 16% consistently screened adult patients for excessive alcohol
use. Less than 20% of physicians used a recommended screening tool. The study identified limited
time and insufficient treatment options for patients with drinking problems as significant barriers to
screening. The research indicates a low frequency of screening for excessive drinking.
The study conducted by Williams and Fish (2020) addresses the need for improvement in mental
health and substance abuse treatment accessibility for the LGBTQ+ population. Their research reveals
a concerning gap in the availability of culturally competent services, despite the documented need
5
within this community. The findings underscore the importance of targeted interventions to address
disparities in access to care for LGBTQ+ individuals, advocating for initiatives that enhance
inclusivity and cater to the specific needs of this demographic (Williams & Fish, 2020).
Ressel et al. (2020) contribute valuable insights by conducting a systematic review of the risk
and protective factors associated with substance use in individuals with autism spectrum disorders.
The review highlights a shift in understanding, challenging the initial belief that symptoms
characteristic of autism protect individuals from substance abuse. Identifies a substantial cooccurrence of substance abuse in this population, necessitating a nuanced understanding of risk and
protective factors. This study emphasizes the need for tailored interventions and heightened awareness
among service providers to effectively address the unique challenges faced by individuals with autism
spectrum disorders and substance abuse concerns (Ressel et al., 2020).
Together, these studies underscore the critical need for the proposed project, providing empirical
evidence supporting the urgency to enhance Medication-Assisted Treatment (MAT) referral rates
through implementing Alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT)
tools. By addressing the identified barriers, the project aims to improve access to comprehensive care
for individuals with co-occurring disorders, aligning to optimize treatment outcomes and promote
inclusive healthcare practices.
6
For the community mental health center providers (P), how does the required per-visit
implementation of the Alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT) tools
PICOT
(I) compared to current practice (C) affect the referral rate to Medication-Assisted-Treatment (MAT)
program (O) over 12 weeks (T)?
7
The project’s overarching aim is to enhance Medication-Assisted Treatment (MAT) referral rates
at Banyan Health System through implementing Alcohol Screening, Brief Intervention, and Referral
to Treatment (SBIRT) tools. The primary goal is to establish a standardized and effective process for
identifying and referring individuals with alcohol-related concerns to the MAT program within the
community mental health center.
The anticipated impact of the current project focuses on three key areas. Firstly, there is an
expectation of improved patient outcomes. By increasing the referral rate to Medication-Assisted
Treatment (MAT) services, the project aims to enhance treatment engagement and retention rates,
ultimately boosting the overall recovery success for individuals with co-occurring substance use
disorders, especially those involving alcohol misuse. This approach is grounded in the belief that more
Project Aim
effective referrals can lead to better patient support and recovery pathways.
Secondly, the project anticipates streamlined healthcare delivery. Implementing Screening, Brief
Intervention, and Referral to Treatment (SBIRT) tools is expected to enhance the efficiency of
healthcare providers. This improvement will be particularly evident in their ability to identify and
address alcohol-related concerns. Such efficiency is about faster care and more effective and focused
delivery, ensuring patients receive the proper care at the right time.
Lastly, the project focuses on cost savings. Aims to evaluate the impact on healthcare resources
and expenses, emphasizing potential cost savings. This aspect underscores the importance of efficient
and targeted interventions in optimizing resource utilization. By improving the way healthcare
resources are used, especially in the context of substance use disorders, the project hopes to
8
demonstrate that well-planned and implemented interventions can lead to significant economic
benefits alongside the primary goal of enhanced patient care.
The importance of addressing this issue is underscored by the pressing need to improve the
current practice at Banyan Health System, where the lack of a systematic process for alcohol
screening and referral poses challenges to effective MAT services. Co-occurring substance use
disorders, particularly alcohol misuse, represent a significant barrier to successful treatment outcomes,
necessitating a targeted intervention to bridge this gap.
Historically, the challenges in identifying and referring individuals with alcohol-related concerns
to MAT services have been recognized within the broader healthcare landscape. National studies, such
as those by Babor et al. (2023) and Karno et al. (2021), have emphasized the effectiveness of SBIRT
tools in addressing substance abuse. Banyan Health System’s historical data, coupled with national
evidence, further supports the imperative to implement a standardized approach for alcohol screening
and referral to enhance the overall quality of care provided to the community.
9
Part II
Stakeholders
The identified stakeholders encompass pivotal roles within the project, including Dr. M. Trujillo
the Chief Medical Officer, influencing organizational direction; T. Aguila, RN, a Registered Nurse
crucial for direct patient interaction and intervention implementation; J. Reid, the Director of
Employee Development and Compliance, ensuring staff training and integration into routine practice;
Stakeholder
and Y. Mendez, the MAT Program Manager, offering insights into MAT program dynamics and
contributing to seamless referral processes. Their diverse roles collectively contribute to the project’s
success, addressing challenges from leadership direction to hands-on implementation within the
Banyan Health System.
Initials or fictitious
Title, Role, or
Connection to
name
Affiliation.
the project.
Oversight of
Dr. M. Trujillo
Chief Medical
Officer
medical
operations at
Banyan Health
System
Potential
Contribution
impact (how
to the
affected).
project.
Influencing the
Crucial for
overall culture of
successful
care, Ensuring
implementatio change: Ensuring buy-in
alignment with
n: Leadership
from the medical
organizational
and strategic
leadership team
goals
direction
Barriers or anticipated
challenges, if any
Potential resistance to
10
Directly
involved in
T. Aguila, RN
Registered Nurse
Active
implementing
healthcare staff
SBIRT tools and
engaged in
influencing the
patient care
referral process
to MAT
programs
Ensuring
J. Reid
Director of
Oversees
Employee
training and
Development
development of
and Compliance
healthcare staff
providers receive
adequate training
on SBIRT tools
is essential for
integration into
routine practice
Critical for
the
effectiveness
Resistance to new
of the
practices; Time
intervention:
constraints for training
Direct patient
interaction
Essential for
integration
into routine
Ensuring consistent and
practice:
effective training; Time
Competence
constraints for staff
and
development
preparedness
of providers
11
Crucial for
Aligning the
Directly
Y. Mendez
MAT Program
involved in the
Manager
MAT referral
process
project with the
existing MAT
program,
Ensuring a
seamless referral
process
successful
integration:
Insights into
challenges
and
opportunities
Coordination with existing
MAT processes; Clear
communication channels
within the
MAT
program
12
S. Adams, the Director of Quality Improvement, has been selected to lead the team due to her
extensive experience and role overseeing quality improvement initiatives at Banyan Health System.
Her familiarity with the organizational culture and in-depth knowledge of quality improvement
processes position her as an ideal leader for this project. Sarah’s leadership qualities include strong
emotional intelligence, effective communication skills, and collaborative attributes, all of which
contribute to her success in fostering a positive and inclusive environment within the team.
In addressing ethical practices, diversity, equity, and inclusion, Ms. Adams prioritizes
adherence to ethical guidelines throughout the project. She actively promotes a culture of diversity
and inclusion, recognizing the value of different perspectives in contributing to the project’s success
(Stahl et al., 2021). Ms. Adams ensures equitable practices, providing all team members with equal
Team Leader
opportunities for involvement and contribution.
Ms. Adams ‘s leadership style is participative, emphasizing collaboration and input from team
members. This approach aligns with the nature of quality improvement initiatives, where diverse
perspectives and expertise contribute to successful outcomes (Wang et et al., 2022). To leverage her
leadership role effectively, Ms. Adams employs two distinct leadership approaches. Firstly, she
adopts a transformational leadership approach, inspiring and motivating the team to exceed
expectations and fostering a culture of continuous improvement and innovation. This approach is
particularly effective when initiating new phases of the quality improvement project, encouraging a
shared vision and commitment to excellence.
Ms. Adams employs a servant leadership approach, prioritizing the well-being and
development of team members. This fosters a sense of community and shared purpose within the
team, contributing to enhanced cohesion and individual motivation. In practice, Ms. Adams actively
13
listens to team members’ concerns or challenges. She provides personalized support, such as
additional resources or training, to ensure each member feels valued and supported in their role. By
combining these leadership approaches, Ms. Adams creates a dynamic and supportive environment
that fosters both innovation and individual well-being within the team, ultimately contributing to the
success of the quality improvement effort.
The team members for this project bring diverse qualifications and roles to the table. A. Patel,
a Quality Improvement Specialist, leverages expertise in methodologies like Lean Six Sigma to
ensure the project adheres to industry best practices. J. Rodriguez, a Substance Abuse Counselor,
provides a vital perspective on alcohol-related concerns, ensuring patient-centered interventions. As a
data analyst, M. Nguyen contributes analytical skills and health informatics expertise for effective
data-driven decision-making. Dr P. Borrego, a Physician, offers a clinical viewpoint to align the
project with medical best practices. S. Kim, the Cultural Competency Trainer, ensures an inclusive
Team Members
approach, considering diverse perspectives. Finally, T. Jackson, the Community Outreach
Coordinator, focuses on community needs, facilitating successful project implementation and
acceptance.
14
Team Member
Title
Department or
Credentials or
Affiliation
Qualifications
Rationale for
selection/Contribution to
the project
A. Patel brings expertise in
quality improvement
A. Patel
Quality Improvement
Quality Improvement
Specialist
Department
M.S. in Healthcare
methodologies, ensuring the
Administration; Lean
project aligns with industry
Six Sigma Green Belt
best practices and
contributes to data-driven
decision-making.
J. Rodriguez’s background
Licensed Clinical
J. Rodriguez
Substance Abuse
Behavioral Health
Counselor
Services
Social Worker
(LCSW); Substance
Abuse Counseling
Certification
in substance abuse
counseling brings a crucial
perspective to address the
project’s focus on alcoholrelated concerns, ensuring
patient-centered and
empathetic interventions.
15
M. Nguyen’s analytical
skills and experience in
B.S. in Health
M. Nguyen
Data Analyst
Health Information
Informatics; Certified
Management
Health Data Analyst
(CHDA)
health informatics
contribute to effective data
collection and analysis,
facilitating evidence-based
decision-making in the
quality improvement
process.
As a Psychiatrist, Dr.
Borrego provides a clinical
P. Borrego
Psychiatrist
Behavioral Health
Doctor of Medicine
(MD); Psychiatrist
perspective, ensuring the
project addresses the needs
of patients comprehensively
and aligns with medical best
practices.
16
S. Kim’s expertise in
cultural competency ensures
S. Kim
Cultural Competency
Diversity and
Trainer
Inclusion Department
M.A. in Cross-
that the project considers
Cultural
diverse perspectives,
Communication;
fostering an inclusive
Certified Diversity
approach in implementing
Professional (CDP)
Alcohol Screening, Brief
Intervention, and Referral to
Treatment (SBIRT) tools.
T. Jackson’s role in
community outreach
T. Jackson
Community Outreach
Coordinator
Community
Engagement
Department
B.A. in Community
ensures that the project is
Health; Experience in
attuned to the specific needs
community outreach
and concerns of the local
and engagement
community, facilitating
successful implementation
and acceptance.
Communication Plan
The communication plan aims to ensure effective and tailored communication with team members and stakeholders
throughout the project. Outlines the purpose, frequency, methods, responsible person, and potential challenges or assets for each
communication, addressing diverse needs and fostering engagement. This strategic approach recognizes individual roles, expertise,
and potential obstacles to enhance project success.
17
Team
What is the
Frequency and
Method of
Who is
Potential challenges/
Member/Stakeholder.
purpose of
timing of
communication
responsible
barriers or assets with
communication
communication.
(consider
for
communication
(Inform, share,
(How often,
audience,
communicati
(barriers, language,
engage, solicit
specific stages
method,
ng with this
culture, different
information)?
of a project?)
culture,
member?
disciplines, best
language,
(Why is it
practices
inclusion).
important
who delivers
the
message?)
A. Patel
Inform, Engage,
Bi-weekly
Team meetings,
Team Leader
Ensure that A. Patel stays
and Solicit
during project
email updates,
or Project
informed about quality
Information
implementation;
and periodic
Manager
improvement initiatives,
Monthly during
progress reports
planning
addresses potential
challenges with varied
communication
preferences, and fosters
engagement through open
communication channels.
18
J. Rodriguez
Inform, Engage,
Bi-weekly
Team meetings,
Team Leader
Effective communication
and Solicit
during project
email updates,
or Project
with J. Rodriguez involves
Information
implementation;
and periodic
Manager
addressing potential
Monthly during
progress reports
language barriers and
planning
ensuring that substance
abuse counseling
perspectives are integrated
into project developments.
Asset: Unique clinical
insights.
M. Nguyen
Inform, Engage,
Bi-weekly
Team meetings,
Team Leader
M. Nguyen’s
and Solicit
during project
email updates,
or Project
communication may
Information
implementation;
and periodic
Manager
benefit from tailored data-
Monthly during
progress reports
planning
focused updates and
ensuring that health
informatics perspectives
are considered. Asset:
Analytical skills for
effective data-driven
decision-making.
19
P. Borrego
Inform, Engage,
Bi-weekly
Team meetings,
Team Leader
Regular communication
and Solicit
during project
email updates,
or Project
with P. Borrego ensures
Information
implementation;
and periodic
Manager
that clinical perspectives
Monthly during
progress reports
align with project goals
planning
and that family medicine
insights contribute to
comprehensive care.
Challenges may include
time constraints. Asset:
Clinical expertise.
S. Kim
Inform, Engage,
Bi-weekly
Team meetings,
Team Leader
Communication with S.
and Solicit
during project
email updates,
or Project
Kim should include
Information
implementation;
and periodic
Manager
cultural competency and
Monthly during
progress reports
planning
diversity considerations,
ensuring an inclusive
approach to project
implementation (Mayo,
2020). Asset: Expertise in
fostering cultural
inclusivity.
20
T. Jackson
Inform, Engage,
Bi-weekly
Team meetings,
Team Leader
Tailoring communication
and Solicit
during project
email updates,
or Project
to T. Jackson involves
Information
implementation;
and periodic
Manager
recognizing the
Monthly during
progress reports
importance of community
planning
outreach insights in
shaping the project’s
success. Asset: Direct
connection to community
perspectives.
Dr. M. Trujillo
Inform and
Quarterly project
Virtual meetings
Team Leader
Communication with Dr.
Engage
reviews and
and written
or Project
M. Trujillo should focus
Manager
on aligning project goals
monthly progress updates
reports
with organizational
strategies and addressing
potential time constraints.
Asset: Strategic direction
and support from
leadership.
21
T. Aguila, RN
Inform and
Bi-monthly
Virtual meetings
Team Leader
Effective communication
Engage
updates on
and tailored
or Project
with T. Aguila involves
project
emails
Manager
ensuring that nursing
developments
perspectives align with
project goals and
addressing potential
challenges related to
varied communication
preferences. Asset:
Clinical and patientcentered insights.
Sarah Adams
Inform, Engage,
Weekly updates
Team meetings,
Project
Communication with
and Solicit
during project
email updates,
Manager or
Sarah Adams should
Information
implementation;
and periodic
Executive
ensure alignment with
Bi-weekly
progress reports
Sponsor
quality improvement goals
during planning
and address potential
challenges in executivelevel understanding.
Asset: Leadership support
and guidance.
22
J. Reid
Inform and
Monthly updates
Virtual meetings
Project
Communication with J.
Engage
on training and
and tailored
Manager or
Reid should focus on
development
emails
Executive
training initiatives and
Sponsor
address potential
initiatives
challenges in ensuring
consistent and effective
training for healthcare
staff. Asset: Expertise in
training and development.
Y. Mendez
Inform and
Monthly updates
Virtual meetings
Project
Communication with Y.
Engage
on MAT
and tailored
Manager or
Mendez ensures alignment
program
emails
Executive
with MAT program goals
Sponsor
and addresses potential
developments
challenges related to
program dynamics. Asset:
Insights into challenges
and opportunities within
MAT programs.
23
Executive Sponsor
Inform and
Quarterly project
Virtual meetings
Team Leader
Communication with the
Engage
reviews and
and written
or Project
Executive Sponsor should
Manager
focus on aligning the
monthly progress updates
reports
project with
organizational strategies
and addressing potential
challenges in ensuring
executive-level
understanding. Asset:
Leadership support and
strategic direction.
24
Intervention and Measurement
25
Planned Intervention
Interventions:
1.
Provider Training and Education Program
2.
Integration of SBIRT into Clinical Workflows
3.
Feedback and Continuous Quality Improvement (CQI) Process
Incorporating evidence-based practices is paramount to the success of the proposed
interventions. The Provider Training and Education Program, aimed at enhancing the skills of
healthcare professionals in addressing mental health and substance abuse concerns, finds support in
the study conducted by Moser et al. (2020). The research highlights the effectiveness of a best practice
quality improvement process in identifying and eliminating barriers to integrating Screening, Brief
Intervention, and Referral to Treatment (SBIRT) in a Federally Qualified Health Center. The results
demonstrate improvements in workflow related to SBIRT, emphasizing the positive impact of targeted
training programs (Moser et al., 2020).
The Integration of SBIRT into Clinical Workflows aligns with the findings from Evans,
Kamon, and Turner’s (2023) study, which explores a 5-year SBIRT effort using a mixed-methods
approach. The research delves into the challenges and successes of integrating SBIRT into routine
clinical practice, emphasizing the importance of a supportive outer context, key facilitators, and the
impact of site and patient characteristics. This evidence supports the rationale behind integrating
SBIRT into clinical workflows, ensuring a comprehensive and adaptable approach to address
variations in service delivery (Evans et al., 2023).
The Feedback and Continuous Quality Improvement (CQI) Process draws support from the
work of Nordberg, McAleavey, and Moltu (2021), which emphasizes the importance of continuous
quality improvement in measure development. The study discusses the iterative cycles of measure
26
development, focusing on stakeholder feedback and systematic improvements. This evidence
reinforces the significance of implementing a structured CQI process to enhance the effectiveness of
the proposed Feedback and CQI Process in the project (Nordberg et al., 2021).
Gardner-Buckshaw et al. (2023) provide valuable insights into increasing primary care
utilization of Medication-Assisted Treatment (MAT) for Opioid Use Disorder. Their research
highlights the effectiveness of a MAT training program designed for primary care providers, resulting
in increased confidence and willingness to implement MAT. This evidence supports the planned
intervention, affirming the importance of targeted training programs to enhance the utilization of
MAT in primary care settings (Gardner-Buckshaw et al., 2023).
The collaborative implementation of an evidence-based package for integrated primary
mental healthcare in South Africa, as detailed by Gigaba et al. (2023), serves as a model for utilizing a
continuous quality improvement (CQI) approach to embed mental health interventions into routine
care. This study emphasizes the effectiveness of a CQI strategy to facilitate the embedding of
evidence-based interventions, supporting the planned Feedback and CQI Process in the project
(Gigaba et al., 2023).
Provider Training and Education Program is shown in Appendix 2.
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Improvement Model / Framework
The selected improvement model for this project is the Plan-Do-Study-Act (PDSA) cycle, a vital element of the Model for
Improvement. This well-established framework is widely recognized in healthcare settings for its effectiveness in facilitating
iterative and continuous quality improvement. The rationale behind choosing this model is multi-faceted.
Firstly, the iterative nature of the PDSA cycle is well-aligned with the adaptive approach required for the planned
interventions. The cycle’s distinct phases – Plan, Do, Study, Act – provide a systematic method for testing changes on a small
scale, evaluating the outcomes, and then refining the approach based on these findings. This process ensures that interventions
constantly evolve and improve in response to real-world feedback and results.
Secondly, the PDSA c…