Using Implementation Science for Community-Based SBIRT Delivery to Older Adults

Howard University, Washington DC

Investigators

Linked publications & trials

Abstract

? DESCRIPTION (provided by applicant): Older adults experience chronic pain-related conditions, sleeping disorders, and anxiety and depression that are treated with prescription drugs and over-the-counter medications, often with potentially dangerous interactions with alcohol and across medications. Importantly, levels of alcohol use that are relatively safe for most adults may be unsafe for many older adults, both because of drug interactions and because of differences in metabolism and elimination and may result in accidents and impairments in activities of daily living, leading to increased emergency department and physician visits and hospitalizations. Health care analysts project that by 2030 the number of older adults with behavioral health conditions, including substance abuse disorder, will equal or exceed the number of younger people with these disorders. With these changes occurring, aging baby boomers will require a significant shift in behavioral health and substance abuse/misuse prevention strategies and treatments in the next two decades. The Primary Care Research in Substance Abuse and Mental Health for the Elderly and the Florida BRITE studies demonstrated that brief interventions have a positive impact for older adults. However, as with many interventions, there is concern about the timely translation of SBIRT from research to community-based social and health care settings. Despite the strong research support for SBIRT, its widespread and sustained implementation has not occurred. Several distinct barriers to implementation have been identified including workflow hurdles and providers' time constraints as well as issues around reimbursement and privacy. While strategies for dissemination have been suggested, evidence-based practices for guiding health care or social service professionals as to how to implement and sustain SBIRT are non-existent. The proposed pilot study will collect Information using a mixed methods approach guided by implementation science, specifically the Quality Implementation Framework. The findings will be reviewed by a Collaborative Team composed of the researchers and members of the participating service sites. This information will form the basis for the SBIRT Implementation Protocol (SIP) that will be evaluated in a larger RCT. The SIP represents an innovation for the field to have evidence-based practices and programs adopted and implemented by community service providers with quality, and sustained over time. The study aims are to: 1) Identify organizational- and staff-based barriers and facilitators relevant for the successful implementation of SBIRT 2) Implement SBIRT in community partner organizations 3) Assess the ability to recruit and retain older adults in the SBIRT program: a) identify provider specific barriers and facilitators for program reach of the target population and b) identify characteristic of older adults related to participation and retention in the SBIRT program; and, 4) Identify provider-specific technical assistants needs for continuous delivery of SBIRT and adherence to the SBIRT procedures and its sustainability over a six month period.