Implementation of a Brief Treatment Counseling Toolkit in Federally Qualified Healthcare Centers: Patient and Clinician Utilization and Satisfaction.
BACKGROUND
The need to integrate behavioral health care within medical settings is widely recognized, and integrative care approaches are associated with improved outcomes for a range of disorders. As substance use treatment integration efforts expand within primary care settings, training behavioral health providers in evidence-based brief treatment models that are cost-effective and easily fit within the medical flow is essential.


METHODS
Guided by principles drawn from Diffusion of Innovations theory (Rogers, 2003) and the Consolidated Framework of Implementation Research (Damschroder et al., 2009), we adapted elements of Motivational Enhancement Therapy, cognitive-behavioral therapy, and 12-step facilitation into a brief counseling toolkit. The toolkit is a menu driven assortment of 35 separate structured clinical interventions that each include client takeaway resources to reinforce brief clinical contacts. We then implemented this toolkit in the context of a randomized clinical trial in three Federally Qualified Healthcare Centers. Behavioral Health Consultants (BHCs) used a pre-screening model wherein 10,935 patients received a brief initial screener, and 2011 received more in-depth substance use screening. Six hundred patients were assigned to either a single session brief intervention or an expanded brief treatment encompassing up to five additional sessions. We conducted structured interviews with patients, medical providers, and BHCs to obtain feedback on toolkit implementation.


RESULTS
On average, patients assigned to brief treatment attended 3.29 sessions. Fifty eight percent of patients reported using most or all of the educational materials provided to them. Patients assigned to brief treatment reported that the BHC sessions were somewhat more helpful than did patients assigned to a single session brief intervention (p=.072). BHCs generally reported that the addition of the toolkit was helpful to their work in delivering screening and brief treatment.


CONCLUSIONS
This work is significant because it provides support to clinicians in delivering evidence-based brief interventions and has been formatted into presentation styles that can be presented flexibly depending on patient need.
Treatment Research Institute, 600 Public Ledger Building, 150S. Independence Mall West, Philadelphia, PA 19106, USA. Electronic address: abrooks@tresearch.org.
Adam C
AC
Brooks
Treatment Research Institute, 600 Public Ledger Building, 150S. Independence Mall West, Philadelphia, PA 19106, USA. Electronic address: jchambers@tresearch.org.
Jaclyn E
JE
Chambers
Public Health Management Corporation, Centre Square East, 1500 Market St. 15th Floor, Philadelphia, PA 19102, USA. Electronic address: jennifer@phmc.org.
Jennifer
J
Lauby
Treatment Research Institute, 600 Public Ledger Building, 150S. Independence Mall West, Philadelphia, PA 19106, USA.
Elizabeth
E
Byrne
Treatment Research Institute, 600 Public Ledger Building, 150S. Independence Mall West, Philadelphia, PA 19106, USA. Electronic address: ccarpenedo@tresearch.org.
Carolyn M
CM
Carpenedo
Treatment Research Institute, 600 Public Ledger Building, 150S. Independence Mall West, Philadelphia, PA 19106, USA; University of Pennsylvania School of Medicine, Department of Psychiatry, 3900 Chestnut Street, Philadelphia, PA 19104, USA. Electronic address: lbenishek@tresearch.org.
Lois A
LA
Benishek
Treatment Research Institute, 600 Public Ledger Building, 150S. Independence Mall West, Philadelphia, PA 19106, USA; Widener University, The Institute for Graduate Clinical Psychology, One University Place, Chester, PA, 19013. Electronic address: rmedvin@tresearch.org.
Rachel
R
Medvin
Treatment Research Institute, 600 Public Ledger Building, 150S. Independence Mall West, Philadelphia, PA 19106, USA; University of Pennsylvania School of Medicine, Department of Psychiatry, 3900 Chestnut Street, Philadelphia, PA 19104, USA. Electronic address: dsm@mail.med.upenn.edu.
David S
DS
Metzger
Treatment Research Institute, 600 Public Ledger Building, 150S. Independence Mall West, Philadelphia, PA 19106, USA; University of Pennsylvania School of Medicine, Department of Psychiatry, 3900 Chestnut Street, Philadelphia, PA 19104, USA. Electronic address: kkirby@tresearch.org.
Kimberly C
KC
Kirby
D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D003376:Counseling / Q000379:methods*; D019033:Delivery of Health Care, Integrated / Q000706:statistics & numerical data*; D006801:Humans; D008605:Mental Health Services / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000628:therapy*
Brief intervention; Brief treatment; Primary care; SBIRT; Satisfaction; Substance abuse