title: A team approach to systematic behavioral screening and intervention.
abstract: OBJECTIVE
  Unhealthy behaviors are responsible for most chronic disease, ample healthcare costs, and around 40% of deaths. This study assessed patient satisfaction and behavioral outcomes for a program that enables healthcare settings to deliver evidence-based, cost-saving behavioral screening and intervention (BSI) services, as recommended by the US Preventive Services Task Force and others.
  
  
  METHODS
  Pre-post program evaluation.
  
  
  METHODS
  Thirty-one diverse primary care clinics and 2 other sites participated. Over 110,000 patients completed multibehavioral screening questionnaires. Those with positive alcohol or drug screens met with dedicated, on-site health educators for further assessment, and then received either reinforcement, brief intervention, or referral. Over 300 patients completed satisfaction questionnaires during year 3 of the program. A pseudo-randomly selected group of 675 patients participated in a 6-month follow-up telephone interview. In addition, for a short time in a pilot project at 3 clinics, 29 patients received depression screening, collaborative care, and behavioral activation, and 22 completed a 3-month follow-up telephone interview.
  
  
  RESULTS
  Mean patient satisfaction scores for all services exceeded 4.2 on a 5-point scale. Over 6 months, binge drinking episodes declined by over 20% for most subgroups. Recent marijuana use decreased by 15%. Depression symptom scores decreased by 55%.
  
  
  CONCLUSIONS
  With intensive training and ongoing support, cost-efficient paraprofessionals can deliver effective alcohol, drug, and depression screening and intervention services in busy healthcare settings. The approach holds promise for systematically addressing on a population-wide basis a variety of important behavioral health determinants and reducing related healthcare costs.
authors.affiliation: 1100 Delaplaine St, Madison, WI 53715. E-mail: rlbrown@ wisc.edu.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Brown
authors.forename: Paul D
authors.initials: PD
authors.lastname: Moberg
authors.forename: Joyce B
authors.initials: JB
authors.lastname: Allen
authors.forename: Candace T
authors.initials: CT
authors.lastname: Peterson
authors.forename: Laura A
authors.initials: LA
authors.lastname: Saunders
authors.forename: Mia D
authors.initials: MD
authors.lastname: Croyle
authors.forename: Robin M
authors.initials: RM
authors.lastname: Lecoanet
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Linnan
authors.forename: Kim
authors.initials: K
authors.lastname: Briedenbach
authors.forename: Scott B
authors.initials: SB
authors.lastname: Caldwell
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology*; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D015438:Health Behavior; D006266:Health Education / Q000458:organization & administration*; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010358:Patient Participation / Q000706:statistics & numerical data; D010865:Pilot Projects; D015995:Prevalence; D011320:Primary Health Care / Q000458:organization & administration; D018570:Risk Assessment; D057566:Self Report; D017678:Sex Distribution; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014922:Wisconsin / Q000453:epidemiology; D055815:Young Adult