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Amy Shanahan: Welcome, welcome back!
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Amy Shanahan: We do, invite folks to say hello in the chat.
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Amy Shanahan: Remind us where you’re from, just… that’s part of the roll call.
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Amy Shanahan: And we’re talking today a little bridge, from last time when we talked about brief intervention, so we’ll cover that. Maybe some things popped up. Happy to see some folks reached out for some technical assistance, which is beautiful, that’s what we’re here for. Anything related to SBIRT implementation.
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Amy Shanahan: not just brief intervention. It has been… has been my experience sometimes that folks, want more practice, or want maybe more independent practice, because it can be, vulnerable to,
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Amy Shanahan: roleplay in front of others, although we did a little bit of role-playing last time on what would you say next?
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Amy Shanahan: And I also invite folks to think about
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Amy Shanahan: What would you say next, and how would you receive it if…
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Amy Shanahan: Said person asks you the question, I often offer up my experiences of
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Amy Shanahan: when medical folks have asked me questions like leading the witness and feeding the answers, not what we want to do in screening or when we’re doing brief interventions. So a little reflection on what we did last time.
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Amy Shanahan: We could do a little bit more practice on what you might say.
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Amy Shanahan: And then we’re really gonna focus on referral to treatment, which seems like it’s self-explanatory. And, yet there are things that we want to make sure that you have in your repertoire of things to do around referral to treatment.
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Amy Shanahan: And any question and answer about that, and then the DSAM folks will,
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Amy Shanahan: Wrap us up with fidelity monitoring and next steps.
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Amy Shanahan: So, I like to take the screen down to see faces, to hear your voices, and…
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Amy Shanahan: Because this is about you and for you, so that’s what I like to share, too.
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Amy Shanahan: What, thoughts do you have since our last session, or what… what things came to mind, or… or maybe if there were folks that weren’t here last time, what would you say about that?
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Amy Shanahan: Say about brief interventions, what’s come to mind?
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Amy Shanahan: All right, Don.
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Dawn Sheehan: This is kind of along those lines, so we have the resource center here, and everybody that comes in, we do the SBERT with, and what we’ve noticed is, is that, asking the questions in front of other people obviously is uncomfortable, so we, but when we get busy, we have two iPads, but sometimes we even get busier than that, so we have a paper form, because when we have the iPads, we simply hand it to them.
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Dawn Sheehan: But what we’re noticing is.
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Dawn Sheehan: when we do the paper form, if the other two iPads are, you know, being used, they’re less likely to answer. We had a guy and a girl in today, and while Rebecca was doing it on paper, because the other two, iPads were being utilized, they’re just looking around the room, you know? So, I don’t know how everybody else does it, but we have decided that we are, you know, if we miss one or two because we don’t want to answer.
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Dawn Sheehan: you know, we don’t want to embarrass them and ask them, you know, sometimes I think that’s what it is.
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Dawn Sheehan: Also, on outreach missions, we are doing the iPad.
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Dawn Sheehan: But it’s kind of dangerous, we’re finding, sometimes, to take the iPad with you in some of these encampments. So, we have opted, I think, in the future to only do paper form then.
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Dawn Sheehan: Yeah, it’s not… it’s not only dangerous, but…
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Dawn Sheehan: They don’t like the whole computer thing. For some reason, they think we’re doing something else.
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Dawn Sheehan: So…
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Dawn Sheehan: We would rather go over to them with paper and that element, because with the computer, they think it’s attached to something else that we’re telling some…
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Dawn Sheehan: It leads them in their minds to go elsewhere.
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Amy Shanahan: Well, that’s a really, good example, maybe for other folks, and certainly other folks could chime in, about what do you do when there’s people in a similar area, whether you’re hearing each other, or doing the screening, or maybe even a little…
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Amy Shanahan: early brief intervention in the exchange. Because it…
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Amy Shanahan: And certainly having a backup plan for the paper, that’s such a beautiful backup plan, especially… you don’t know where folks are, especially when they’re in the street, or like you said, in encampments. We don’t know where they are in their level of wellness, and they may be concerned about what you’re up to, or what’s on the computer, or, you know…
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Amy Shanahan: Yeah.
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Dawn Sheehan: dealing with a lot of mental health issues, I believe, too, and I think that’s part of it, because not only are we, you know.
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Dawn Sheehan: doing this, you know, sometimes if they’re having a mental health crisis or having issues, then they really are thinking, kind of, out there. Out there, you know what I mean?
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Amy Shanahan: Big Brother’s watching.
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Amy Shanahan: Andree.
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Andree Mosley/Unique Minds: Andre.
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Amy Shanahan: Andre, alright.
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Andree Mosley/Unique Minds: Yeah, what we do at Unique Minds, we, have dividers that separates our desks.
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Andree Mosley/Unique Minds: And what we do is we have a chair right beside our cubicle.
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Andree Mosley/Unique Minds: And, our interaction with the client is… is… is private.
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Andree Mosley/Unique Minds: So, we’re talking, low, reassuring them that everything we’re doing is private, it protects them, their information, and things of that nature. And so, and we do use the iPad, with them, and some clients are not,
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Andree Mosley/Unique Minds: you know, don’t really know how to use it, and so, therefore, we’re hands-on. We walk them through the process, and sometimes we even read the questions for them to get better understanding of what it is we’re doing. And that’s something that we do because people do feel like there is something different.
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Andree Mosley/Unique Minds: The good thing about us is that we know most of the people who comes in.
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Andree Mosley/Unique Minds: because we deal with them in other areas of our program, as far as food, distribution, things of that nature. So they’re fairly comfortable with us, but we do use that privacy
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Andree Mosley/Unique Minds: Divider to make sure that they’re comfortable and really let them know that what sets, what’s here stays here.
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Andree Mosley/Unique Minds: And that is for… is for them. So, that has helped us, with, with how, you know, with our clients.
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Amy Shanahan: Thanks, Andre.
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Amy Shanahan: I remember, in an organization where I worked, we gave blood in the same room.
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Amy Shanahan: But they’d have to ask us certain personal questions about our health, and having even the desktop dividers and them speaking, maybe quieter, felt a little sense of privacy. There’s only so far you could go with the resources, but some good ideas there.
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Amy Shanahan: Other folks… Screening, brief intervention, questions, reflections, where you are in your… Implementation.
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Amy Shanahan: Going once, going twice… Alright, I’ll put the slides up, and we can…
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Amy Shanahan: Carry on with some more of the conversation. I was thinking around,
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Amy Shanahan: brief intervention, last time I shared a simplistic scenario, I’ll… I’ll stick with that, and,
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Amy Shanahan: go through that a little bit and invite you to think about what would you say next? I’m going to add a little twist to this one.
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Amy Shanahan: So, what do you remember? Does folks remember what role I was playing?
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Amy Shanahan: Made it pretty simple.
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Amy Shanahan: So, I was using alcohol, so I made it simple and didn’t add other substances.
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Amy Shanahan: I was of the hazardous category.
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Amy Shanahan: And…
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Amy Shanahan: We, just explored what would we say next about my scoring, about how you would broach the subject.
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Amy Shanahan: Some of you had some beautiful examples of just merely, thanking me for completing the form, doing some engagement, which is always very important. Our tone and how we’re addressing the levels are important.
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Amy Shanahan: But when we’re talking about brief intervention and then referral to treatment, some things that I’ve experienced is that when folks score, harmful or hazardous levels.
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Amy Shanahan: Some providers feel uncomfortable.
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Amy Shanahan: Maybe with having that conversation, and I wonder where you all feel. Are the folks that are going to be doing the brief interventions in your organization already doing it?
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Amy Shanahan: Have you selected folks? How are they doing? Do they feel comfortable? Where are you, if we could pause there, because the next piece of the, brief intervention, I want to add a little twist to it. So, where are folks, if you don’t mind sharing?
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Amy Shanahan: Do you have your, selected employees?
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Amy Shanahan: That are going to be doing the brief intervention.
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Amy Shanahan: It’s a simple yes in the chat, or no, not yet. And then, how are they… how are they with comfort level of having these conversations?
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Amy Shanahan: Thanks.
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Kristy Gibbs/Unique Minds: Try to speak.
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Amy Shanahan: Go ahead.
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Kristy Gibbs/Unique Minds: I can say that my staff is not all that comfortable. We recently
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Kristy Gibbs/Unique Minds: Had a meeting with, Louisa, and, she has reached out to, I believe, your team to assist us with, further training.
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Kristy Gibbs/Unique Minds: I feel like we’ve had several individuals to come in freely and take the screening, but not to actually be referred out.
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Kristy Gibbs/Unique Minds: I feel like a lot of that ha-
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Kristy Gibbs/Unique Minds: It has to do with the comfortability of my staff not being comfortable, because we had a lot of people that did score high. And so I’m hoping that once we train with you all, that those results will get better.
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Kristy Gibbs/Unique Minds: Yeah.
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Amy Shanahan: Thanks, Kristy.
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Amy Shanahan: Appreciate that. Yeah, it’s not always… especially if the folks are not used to having that conversation, if it’s not something they’ve done in the past.
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Amy Shanahan: Especially if we’re used to just doing the checkboxes and making maybe the referral, alright? Alright, Menopause Clinic has got, folks that are
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Amy Shanahan: feeling comfortable. Kevin, you got a mix of people that are doing it, meaning some are better than others, and
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Amy Shanahan: Keep in mind, too, when you… when you reach out for technical assistance, it’s… I don’t know if the right… if the person… not the right, but the people that are doing the brief interventions are here, and we could spend a whole hour just practicing.
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Amy Shanahan: With the people that are gonna be doing it, and again, that’s what the technical assistance is there for you all, and it might feel a little less vulnerable.
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Amy Shanahan: When you’re not with other agencies, and that you’re with each other. So that’s always, an option there, so thanks, Kristy and team, for Unique Minds reaching out.
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Kristy Gibbs/Unique Minds: You’re welcome.
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Amy Shanahan: technical assistance.
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Amy Shanahan: Sometimes, just like doing the screening, if you did the screening yourself, it might feel, rehearsed.
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Amy Shanahan: The first few times,
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Amy Shanahan: Until you start to get comfortable putting your own words to the conversation.
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Amy Shanahan: Alright, anything else?
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Michelle Robinson: Michelle? Yep. Hi, I’m… hello, I’m with the Georgetown Police Department, and it’s just Kristen and myself, and I will say, I think we’re both very comfortable doing the screenings. It’s kind of unique, because we get them when,
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Michelle Robinson: Not always, but sometimes they’re literally sitting in a jail cell, so we kind of use that as a motivator at times, because, you know, again, they’re arrested, and they may or may not be going to be incarcerated, and we’ve actually…
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Michelle Robinson: have used that to our advantage, and we… we thought we had one gentleman into rehab, but he left, and we had to leave
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Michelle Robinson: And by the time, you know, an hour or two went, he saw the judge, he ended up leaving, but we have since then try to follow up with him, and then I had another gentleman last week who was in there, and…
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Michelle Robinson: He was in treatment, but he’s been relapsing, so I’ve encouraged him, and we’re hopefully securing him with some housing. So he was very open to it. So yeah, I kind of use it more as, like, a conversation piece before I actually start the screening, because that way I kind of get an idea where they’re at, but again, we’re…
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Michelle Robinson: Not saying they, they, you know.
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Michelle Robinson: we use that to our advantage, I guess, being, they’re in the justice system, and like I said, and even the officers are like, look, you’re here, you have the clinicians here, take this as an opportunity to, you know, get into treatment, so we work very hard with them, trying to get them at that moment into treatment.
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Amy Shanahan: Yeah.
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Amy Shanahan: You know, thanks, Michelle, and…
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Michelle Robinson: Excellent.
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Amy Shanahan: so wonderful that folks in your area have you there, to bridge some of the… because usually, you know, they go right to jail, or right through adjudication, and don’t have the opportunity to talk with somebody like you. It’s almost like the treatment courts would do that, have a liaison.
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Michelle Robinson: Yes.
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Amy Shanahan: To, to guide people through the systems, and sometimes in your, like, in your example, folks are already exposed and already parts of the, of the care system, and those are usually easy, probably easier, conversations to have. And I guess to that point around
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Amy Shanahan: referral and follow-up. Some may have more access to people than others. So my twist on my case that I played last time, and we don’t have to get into the details of it other than, you know, I probably would be
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Amy Shanahan: As the case scenario last week was, that I…
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Amy Shanahan: potentially or probably would meet a substance use disorder diagnosis in the DSM, but what I would say to folks is we don’t have to always worry about the diagnosis.
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Amy Shanahan: Because we don’t have to make it, necessarily. We’re referring to an agency that will make that decision, and I’ve been on the receiving end in… from treatment courts, from other referring agents that were nervous about,
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Amy Shanahan: having this brief intervention or conversation, they would just refer them to a specialist.
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Amy Shanahan: You know, and then you’re putting someone through a loop that maybe they’re not yet ready to go through, and sometimes they’re not ready for treatment. So, the opportunity to have a brief intervention is right here, right now, so…
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Amy Shanahan: if I didn’t want to go to treatment, or if I wasn’t ready to go to treatment, that’s part of the conversation I want to have right now.
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Amy Shanahan: What would you all say? What do you think you would…
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Amy Shanahan: invite, the person that’s doing your intervention to say, if you are coaching them, or what would you say if you are the interventionist, if you will, I don’t want to go to treatment. You’re having a conversation with me, we talked about my, harmful and hazardous levels of use, and that
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Amy Shanahan: You know, and you engaged me well, and said, you know, that might mean that if you continued at this level.
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Amy Shanahan: I may be at higher risk for health and other related problems, but I’m saying I don’t want a referral. What would you do? I’m kind of beaten up, I’m, I’m, I’m,
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Amy Shanahan: hedging it off that this is in one of my slides later, but I thought, well, this is a time to kind of bridge having a brief intervention, like, what do you do when people don’t want a referral to treatment? Because that’s an important thing to consider. So, wondering what your thoughts are about that.
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Amy Shanahan: Here I am, we had this conversation.
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Amy Shanahan: And you’re wondering if I should be referred for a further assessment, because you’re… you have a hunch that
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Amy Shanahan: It might be pretty bad.
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Amy Shanahan: But I’m not ready yet, I don’t want to go. What would… what would you say?
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Amy Shanahan: What would you offer?
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Mbwidiffu Dibal – Menopause Clinic: Hi, I’m Joan from the Menopause Clinic, and if I was in that position, I would probably try and still hand them some kind of pamphlet or information about going to a site.
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Mbwidiffu Dibal – Menopause Clinic: And just follow up with them, maybe in 3 or 4 days, or 2 days from there, and see if they’ve changed their mind, or if there’s anything else we could do to help them, or guide them to a more specific place, or somebody to…
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Mbwidiffu Dibal – Menopause Clinic: Maybe get them better help.
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Mbwidiffu Dibal – Menopause Clinic: Thank you. But I wouldn’t give up. I would still pursue them every couple of days until they…
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Mbwidiffu Dibal – Menopause Clinic: Hopefully, we’ll decide to get help.
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Amy Shanahan: Beautiful.
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Amy Shanahan: Thanks so much, Joan, and Kevin’s chiming in, as well, about letting them know that when you’re ready, we’re here for you.
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Amy Shanahan: And I’m wondering, as a follow-up, so those are beautiful things, especially the follow-up that you mentioned, Joan, checking in with them. One thing that I found in my, practice of motivational interviewing, which we share that, screening and brief intervention is adopted, adapted from.
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Amy Shanahan: Is…
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Amy Shanahan: always having in my repertoire, my language, when I talk with people. I must have, like, watched a French movie, because I keep sharing repertoire. How many times can I use that in an hour? My go-to is asking permission.
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Amy Shanahan: If you don’t mind, I’d like to follow up with you in a few days, instead of just saying I might follow up, so being clear and being specific, and asking if it’s okay, and then making sure it’s on my calendar.
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Amy Shanahan: I did an intervention with a woman who… who was… who probably could have benefited from… from high levels of care, actually, and she did not want to go. And we…
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Amy Shanahan: asked permission, and we told her that we were going to follow up with her monthly, until she told us to stop calling her.
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Amy Shanahan: And that was our policy and our mission about how we were following up with folks, and we had a person with lived experience, continue to follow up, the same person, so she was used to the same voice on her voicemail.
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Amy Shanahan: And even a year in.
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Amy Shanahan: She was still not wanting to go to treatment, and she called us and said, thank you for not giving up.
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Amy Shanahan: I need to take care of some things, and eventually decided she wanted to go, to get treatment. So, sometimes it’s not tomorrow, next week, next month, but… so I love that plan that you have to follow up. How often do you follow up?
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Amy Shanahan: It’s certainly up to you and your team to decide how many follow-ups.
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Amy Shanahan: So… anything else? Terry writes, find out what their underlying concerns are. So maybe, Terry, you would have a conversation with them about…
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Amy Shanahan: you know, what is it? Maybe I’ve been to treatment before, and I wasn’t happy with it, or maybe it didn’t work.
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Amy Shanahan: Or maybe I have several children at home that I’m responsible for. So, everyone has a different story, right? So, being mindful of the different scenarios.
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Amy Shanahan: Yes, Dawn, planting the seed is always the part, so the biggest piece about this, me adding this twist in the scenario, is that people are ambivalent for a lot of reasons.
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Amy Shanahan: And I owe… when I bring up ambivalence, I invite you all to think, is there anything that you’ve wanted to do differently in your life? Health, wealth, you name it, career changed, and you haven’t done it yet.
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Amy Shanahan: Think about all the reasons why you didn’t yet, why you haven’t started yet.
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Amy Shanahan: Because this level of ambivalence of, oh, I know I need… I know I could benefit from treatment.
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Amy Shanahan: From specialty care. But I don’t want it. For a lot of reasons. Insurance, money, time.
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Amy Shanahan: Fear.
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Amy Shanahan: Did it, tried it, didn’t work. I’m just not ready to give up my substances, or some of them.
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Amy Shanahan: all that jazz. So, being neutral…
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Amy Shanahan: about someone’s ambivalence and not fighting for one side or the other is, backed by evidence, so, being able to let the person hear their own conversation around their change. So, for example, if I… if you’re talking with someone who
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Amy Shanahan: probably could benefit and not ready yet, and I wonder, how often does that happen for y’all? You get that? Where, I don’t want to go.
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Amy Shanahan: Just… just curious about that, but you can highlight their ambivalence With a reflective statement.
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Amy Shanahan: Right now, at this time, you’re not ready to go to a formal program, and you’re still wondering what you might do about your substance use. And this is part and parcel where the brief intervention can come in.
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Amy Shanahan: So, I’m gonna highlight that again and repeat it. It’s a double-sided reflection, we call it, for folks who are familiar.
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Amy Shanahan: And we highlight the staying the same talk first.
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Amy Shanahan: So that the last thing they hear is the change side of what’s going on in their ambivalence, okay?
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Amy Shanahan: So, again, I’ll repeat it. So, you know, at this time, you’re not ready to sign up for or go to a formal treatment program, and at the same time, you’re contemplating what changes you might make for your substances, or your substance use.
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Amy Shanahan: To me, if that double-sided reflection is practiced a lot with folks that are doing brief interventions, and making sure you put the change part at the end…
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Amy Shanahan: you are planting those seeds, right, Don? We’re really highlighting that what they said, we’re not…
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Amy Shanahan: We’re not putting the seed necessarily in the dirt, they already brought it up. So we want to highlight that… that change language that they’re contemplating doing something different.
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Amy Shanahan: So it’s a neutral stance of not pushing either way. I’m gonna ask you this follow-up question, testing your sense of freedom to choose, because that’s where… why this… why this happens. If I,
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Amy Shanahan: said to you, oh, go ahead and do it. You could start, like, Friday, and we’ll all check in with you Friday. Go ahead and do it.
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Amy Shanahan: How do you feel about your change? And I’m saying, go ahead, start it on Friday, you got time, you got, like, 4 days to get it going on.
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Amy Shanahan: What’s going on with folks when I say that in your head?
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Amy Shanahan: Come on, you can make that change. Friday, you got 4 days to plan for it. You got it going on. You could do it.
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Amy Shanahan: No reactions?
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Amy Shanahan: How are you responding to that?
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Amy Shanahan: Am I being too far out.
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Amy Shanahan: A little resistant, are we, Sherry?
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Amy Shanahan: I wanna see people’s faces, I’m gonna stop sharing for a second.
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Amy Shanahan: Come on, you could do it Friday! What do you think?
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Amy Shanahan: Terry, you got it, you could do it. Travis, you can make this change.
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Amy Shanahan: Got all these friends here that’ll help you along.
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Amy Shanahan: What reactions popped up in your head?
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Amy Shanahan: No profanity, though. Just…
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Amy Shanahan: I have a wedding to go to. I love that, Terry. Well, you know what, I think your health is important, your change is important, I think you should cancel that wedding. I’m pushing Sherry a bit, she’s willing to try it out.
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Amy Shanahan: Alright. For folks who are being shy about responding, a lot of times when we push
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Amy Shanahan: for that change, we’ll get a little pushback. And sometimes we decipher it as excuses.
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Amy Shanahan: Oh, Terry’s just making an excuse.
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Amy Shanahan: Sherry doesn’t care about the change. Sherry doesn’t care. She doesn’t want to do it.
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Amy Shanahan: And that’s not really the truth, is it? Because if I pushed you to stay the same, how’s that feel? Don’t worry about it. You don’t have to change, you’re fine the way you are. Ilia likes that one.
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Amy Shanahan: You could stay the same, just don’t worry about it.
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Amy Shanahan: Any reactions to that one?
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Amy Shanahan: Usually I get a thumbs up or something.
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Amy Shanahan: Go ahead, stay the same, you don’t have to change.
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Amy Shanahan: Yeah.
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Amy Shanahan: Small steps.
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Amy Shanahan: If I push for either side of someone’s ambivalence, they’ll push back, typically. Oh, you don’t care for me now, or you don’t care about me. So that double-sided reflection, what do you think about that?
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Amy Shanahan: For use in your toolbox for brief interventions.
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Amy Shanahan: On one hand, you don’t want to make big changes, or go to treatment, or go for an assessment. On the other hand, you’re thinking about doing something different.
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Amy Shanahan: What do you think about that?
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Sherry Szczuka: So I think the big thing is.
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Sherry Szczuka: Helping them understand that just one little change
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Sherry Szczuka: It’s the stepping stone without making them feel overwhelmed with Jumping in with both feet.
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Amy Shanahan: Yep.
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Amy Shanahan: That’s right.
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Amy Shanahan: And part of it is honoring that, and honoring their autonomy to choose.
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Amy Shanahan: What they do and when they do it.
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Amy Shanahan: And I know it sounds…
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Amy Shanahan: sometimes counterintuitive when we’re… feel this urgency, if someone’s in front of us and really might be struggling.
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Amy Shanahan: They could be on a daily basis, that’s their current state. But when we honor their choice, oftentimes I have found anyway, that folks will stay engaged, will stay, oh, you’re not pushing me to go to that rehab, you’re not pushing me to go to treatment.
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Amy Shanahan: So I wanted to circle back to that, because that’s why I wanted to add that twist.
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Amy Shanahan: Because brief interventions are not just a one-time thing.
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Amy Shanahan: If you have the bandwidth and you’re putting it in your processes, brief interventions could be 1, 2, 3, 4 brief sessions.
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Amy Shanahan: You can bring them back in. It doesn’t just have to be a follow-up phone call.
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Amy Shanahan: You can invite them to come in and have another 15-minute conversation with your social worker, your peer, your staff member that’s doing the brief intervention.
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Amy Shanahan: Right, so Kristen, you have an experience there where you may see folks again and again, and that is an opportunity to have this just as part of your conversation.
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Amy Shanahan: And that’s what I would love to do, spending time with folks who want… who want, some technical assistance. We… there’s lots of…
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Amy Shanahan: tools, ask, offer, ask, I offer up a lot.
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Amy Shanahan: I just gave you the double-sided reflection to put in your pocket if you hear that ambivalence. They don’t want to, but they want to do something. Yeah.
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Amy Shanahan: And there can be other things that we could try on as well.
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Amy Shanahan: Yeah.
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Amy Shanahan: So, yeah, Travis, so there’s a psychological reactance in when we push hard for change, even when people think it’s good for them.
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Amy Shanahan: Even if we know it’s good for us, I don’t want to stop.
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Amy Shanahan: You know, my doctor told me I have some high cholesterol, and I gotta start changing my diet. Oh, crap. I don’t wanna do it.
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Amy Shanahan: So… When we’re pushed too hard, we can push…
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Amy Shanahan: To the wrong side of change.
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Amy Shanahan: So what are some things that you find already for folks who are comfortable with brief interventions? What phrasing or things have you used so far? If you could share with your teammates here, your colleagues who are…
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Amy Shanahan: thinking about this, and some aren’t ready yet.
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Amy Shanahan: What pieces of the brief intervention do you… do you use?
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Amy Shanahan: And while you’re thinking about that, I’ll put the slide up that shares the fidelity monitoring around brief intervention, not only as a reminder, but this is part of the process, bringing up the topic, asking permission, is it okay that I offer this?
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Amy Shanahan: Using reflections, open-ended questions, to get us away from our medical model of question, question, question checklists, and I’m exaggerating a little bit there, and providing, information and feedback around the risks associated with
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Amy Shanahan: Last week, I shared, my colleague gave me this phrasing, that I really loved. You know, at this time,
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Amy Shanahan: What you’re sharing with me is…
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Amy Shanahan: from the screening tool, if you continued to use at this level, because, you know, I think we saw in the example video, people, or the one person didn’t like the word hazardous or harmful, that could be judgy?
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Amy Shanahan: And sound pretty big.
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Amy Shanahan: So that might be some of our terminology, so we could share, you know, what this tells me is that this time, based on what you answered, if you continued to use at this pattern, you’d be at…
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Amy Shanahan: a higher risk, or whatever risk they are, for health-related or social-related other issues. So that’s part of it as well.
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Amy Shanahan: And then when you get into the small steps of what they might do, hey, I’m wondering, like Joan said, I’m wondering if it would be okay that we follow up next week together.
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Amy Shanahan: What would be best for you?
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Amy Shanahan: Can I call you? Would you like to stop by and see me for 15 minutes? So that’s a negotiated partnering plan. So, starting to think in terms of that, if you can do that, that would be fabulous.
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Amy Shanahan: Checking the chat… Yeah.
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Amy Shanahan: Yeah, Kristen, and trying to, definitely be more neutral…
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Amy Shanahan: I don’t know if you’ve experienced this, but I definitely have on my… in my end that, from an addiction treatment provider perspective, is folks are, already coming to us, sometimes feeling judged, feeling people have been pushing them, people are, already labeling them with a diagnosis.
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Amy Shanahan: Bill Miller, the co-author of Motivational Interviewing, would often say, clean the slate.
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Amy Shanahan: wipe the… wipe the blackboard, as if you never met this person, and… and it’s from the perspective of… and I share this exaggerated, alright, here comes Amy Shanahan, she’s being referred to you. She’s a pain in the butt, she’s been here a gazillion times, she’s got this, that, and the other diagnosis, and…
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Amy Shanahan: You know, if you are loaded with that data, one, it might be helpful, sometimes it’s needed for billing, of course, but sometimes it can get in our way, to…
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Amy Shanahan: to have to navigate our cobwebs of judgment. And I don’t mean judgment in always a negative way.
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Amy Shanahan: A judgment could be, this person’s got a really bad problem. That’s a judgment, but it comes from our heart.
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Amy Shanahan: So it’s trying to suspend some of that so we can use some of these conversation skills to carry on, so…
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Amy Shanahan: What’s working well for you all, based on your fidelity monitoring? If your fidelity monitoring came out today, what… where would you, be doing well so far?
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Amy Shanahan: I’m just gonna leave this up for you to see.
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Amy Shanahan: Where would you be doing well?
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Amy Shanahan: You could write the number in the chat, or unmute, and…
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Amy Shanahan: Share what’s… what’s going well already.
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Amy Shanahan: And work in progress is an answer.
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Amy Shanahan: Alright, Dawn has been successful in the referral to treatment end of it, so already negotiating that plan.
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Amy Shanahan: Wonderful.
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Amy Shanahan: I know Michelle had two different examples, one…
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Amy Shanahan: Was already engaged in the treatment, and the other one, maybe not, not yet.
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Amy Shanahan: What else? Who else?
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Mbwidiffu Dibal – Menopause Clinic: Hi, this is Joan again. We really haven’t had the opportunity too much in this office, but I feel that every patient, that if we had that
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Mbwidiffu Dibal – Menopause Clinic: reason to approach them, to have an intervention. Everybody is different. Every patient is an individual. Right. And I think you would just have to take that
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Mbwidiffu Dibal – Menopause Clinic: patient, and feel them out, and see how you have to approach them, and just be as empathetic as you can. I think that that’s where the start would be.
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Mbwidiffu Dibal – Menopause Clinic: And then just go from there of… of how their… how they approach you would be how you would approach them. There can’t be one way, right way, wrong way, it’s an individual.
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Mbwidiffu Dibal – Menopause Clinic: one-to-one.
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Mbwidiffu Dibal – Menopause Clinic: And I think that that’s how it would have to be approached.
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Amy Shanahan: Excellent. Thanks, Joan. Yeah, this framing is just that, and the frame of doing a brief intervention is meant to be individualized, so that’s really important, and I’m glad you underscored that.
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Amy Shanahan: And at the same time, it gives us this kind of, here’s the steps I want to take to make sure that I ask permission to…
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Amy Shanahan: Have this conversation, thank the person that’s engaging, and being able to reflect back their answers.
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Amy Shanahan: Let them know I’m listening to understand them, and then being able to provide any kind of feedback related to their risk, or their health, or why you’re seeing them, and how does it relate. And that, again, hopefully, like you’ve already said, that you’re there for them.
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Amy Shanahan: To have a conversation, follow up, and or refer them to treatment when they’re ready.
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Amy Shanahan: So, absolutely, with, individuals, in, in mind.
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Amy Shanahan: And thanks, Travis, for letting us know that none of your responses have yet resulted in a brief intervention.
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Amy Shanahan: You know, and sometimes even just doing the screening and how you have a conversation about the results can be part and parcel of a brief intervention.
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Amy Shanahan: You know, based on your scoring, you’re at low risk,
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Amy Shanahan: good job, thanks for filling this out. That… that can be part of an intervention, even when they don’t score at a… at a rate that results in a brief intervention.
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Amy Shanahan: Just a kind way to say, hey, I’m planting a seed, if you ever need me, or if things change.
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Amy Shanahan: I’m gonna talk to you in a non-judgmental way.
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Amy Shanahan: Alright, I’m gonna read Dawn’s out loud, if folks aren’t looking at the chat. One individual contacted them, asking to facilitate sober living.
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Amy Shanahan: And yeah, having a non-judgmental approach with kindness and compassion is the key. If they feel comfortable with you or your organization, they’ll be more willing to contact you.
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Amy Shanahan: Yeah, and that’s what we adopted to, that no matter where a person was, we…
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Amy Shanahan: we honored their choices and said, we’re gonna be here. And I think what helped us in our follow-up, and this will get us to referral to treatment information.
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Amy Shanahan: When we asked if we could follow up, it always seemed to be, yeah, of course, they’re not gonna say no, but we realized that we had to be specific.
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Amy Shanahan: Is it okay for me to follow up with you next week? If you don’t mind, I’ll follow up with you next week. Can I call you? Can I text you and be specific?
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Amy Shanahan: So here’s some information around referral… referring to treatment. Whoops, everything’s jumping around faster than I need it to, yeah. I’m trying to move your faces so I can see the screen. So,
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Amy Shanahan: You know, and this is… if you’ve seen in the training, in the online training, the pyramid where the top of the pyramid is usually this 5%, this smaller percentage of people, especially if we get more used to this. I mean, some of you may be more exposed to people who are in and out of mental health and substance use care, and that percentage might feel higher for you, but if you took the general public, the data said.
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Amy Shanahan: that 5% of people screened, if we screened everybody, would even require a referral to treatment.
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Amy Shanahan: I’m trying to grab the chat again, so let’s see… Alright.
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Amy Shanahan: Okay.
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Amy Shanahan: Thanks, Victoria’s checking me for time. Beautiful.
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Amy Shanahan: So, again… the appropriate referral is also individualized. Of course, you want to,
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Amy Shanahan: if folks are using in a hazardous way, you would want them to see a specialty, a specialty clinic or a specialty care, but if they’re not ready or willing or able, we already talked about that. So, want to be able to still provide the brief intervention.
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Amy Shanahan: I’ve seen organizations go check, they… it was a referral to treatment client, but they didn’t want it, so…
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Amy Shanahan: Check them off the list.
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Amy Shanahan: I hope that you would adopt, that you can intervene as well, especially if you have folks that you’re gonna see over and over again.
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Amy Shanahan: If that’s possible.
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Amy Shanahan: Always important to follow the confidentiality laws, and this is going to be important if you’re not a provider of substance use disorder. The person that you’re referring to may be. So, if you can have them sign a consent, to share information so that you can continue to follow up, that would be probably helpful.
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Amy Shanahan: One thing that is, if it’s here, certainly makes sense. If you haven’t done so already, or if you don’t already have a relationship with folks in your area that you work with,
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Amy Shanahan: It’s a… it’s a good time to…
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Amy Shanahan: break bread and hang out, have coffee with someone in another agency, and get to know agencies better.
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Amy Shanahan: you know, some are better than others. Some might meet the needs of the people that you’re serving.
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Amy Shanahan: I worked in an organization where we were referring to a specific entity, and that
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Amy Shanahan: doesn’t work, because people are different. Some want to be in their community, some don’t want to be in their community. So getting to know that a little bit as well, if someone goes to specialty care, will they do better in their own community, or referring a little bit on the outskirts? Or they might not want to go back to a provider that they’ve been to several times.
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Amy Shanahan: So that’s something to consider as well.
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Amy Shanahan: And it’s all about reducing, barriers and you being able to be part of the system that’s, collaborating together.
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Amy Shanahan: Little bit about this warm handoff. The warmer the better is an in-person thing. In-person warm handoff, not just a phone call, if it’s possible. And I’m wondering how many of you thought of this so far? How many of you, by show of…
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Amy Shanahan: chat have considered, how you’re gonna navigate in your process a warm handoff for folks.
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Amy Shanahan: Yes or no is, it’s a closed question. How many of you contemplated this? So, yes or no, you’ve contemplated the warm handoff yet?
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Amy Shanahan: So just some things on the slide here to…
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Amy Shanahan: Alright, Kristen, you’re doing warm handoff. Beautiful.
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Amy Shanahan: If you can, as warm as possible,
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Amy Shanahan: If you’re referring, obviously, in your own practice, if that’s a possibility, that’s beautiful, that’s…
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Amy Shanahan: probably the easier warm handoff where you could walk them down the hall, or introduce them to the person that they might be seeing. Beautiful, and if it’s outside of your practice,
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Amy Shanahan: That this is the important part about getting to know another organization, and people in those organizations, that you’re able to talk about them.
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Amy Shanahan: share they’re warm and friendly, if that’s true. And then being as clear and specific as you possibly can be. Hey, you’ll be seeing Amy when you go to said program.
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Amy Shanahan: Yeah, so being able to make it as tight and specific as you possibly can.
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Amy Shanahan: Yeah, sure, Travis, that makes sense. So if you have a,
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Amy Shanahan: physical therapist or a care provider of one or two, you might be limited there. And, you know, I don’t know if this is possible, but we did this in other organizations, it happened organically, that we actually were able to find people in the community with lived experience that were willing to work with us to make some connections, even though they worked in the community.
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Amy Shanahan: I was in a bigger city in Pittsburgh, so that seemed to be a resource that was, easier for us, so people with lived experience were willing to come to health clinics, too.
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Amy Shanahan: Or be called by, yeah.
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Amy Shanahan: Alright, Terry, you have a CHW who makes referrals. What would… what would a CHW mean to folks?
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Terry Towne: She is a community health worker and works mostly on the weekends in the ED, and her purpose is to help, prevent readmissions.
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Amy Shanahan: Excellent. Alright, community health worker.
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Terry Towne: Alright, just…
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Amy Shanahan: Making sure everybody knows the letters. Beautiful.
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Terry Towne: And we’re trying to get more, but right now we just have her. She’s indispensable.
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Amy Shanahan: Yeah, when you get them, you don’t want to lose them. We tried to have, our own peers, be in the ERs, EDs, and the EDs couldn’t have it. They didn’t have space for them, and there was, you know, other things. So that’s why it can be helpful if you have the bandwidth to get to know your community providers, and…
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Amy Shanahan: I ended up having meetings with them quarterly so we could, brainstorm on things like this. So Terry has a community health worker that works with their organization.
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Amy Shanahan: And facilitating a handoff is not just giving them a card with a phone number, it’s calling to make the appointment for the person.
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Amy Shanahan: Even better, with them while they’re in the room?
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Amy Shanahan: Of course.
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Amy Shanahan: Providing directions, letting them know where the place is. If you have the
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Amy Shanahan: opportunity to coordinate transportation. And again, in capital letters, always ensure follow-up, no matter what the outcome is, no matter where they’re going, is it okay that I follow up with you to check in next week, or next month, or whenever their appointment was, if you made one?
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Amy Shanahan: I would love to check in with you,
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Amy Shanahan: And also, with signed consents for care coordination, call the referring organization, to check in to see if they’re there. And I believe that that would be a good follow-up in your records as well.
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Amy Shanahan: So I had the slide up, talked a little fast, just wondering any thoughts that folks have around the referral to treatment. I already covered the,
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Amy Shanahan: And you all shared your examples of what if the person doesn’t want a referral?
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Amy Shanahan: Again, encourage follow-up. I would be even more specific to say, make an appointment with them to follow up. If it’s in your,
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Amy Shanahan: If it’s in your bandwidth, then you could do that.
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Amy Shanahan: Have them come back.
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Amy Shanahan: Alright, Dawn has her… Follow-up, warm handoff, follow-up, introducing clients by phone,
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Amy Shanahan: Yeah, it’s great if you can tr… if you can help with transportation.
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Amy Shanahan: Yeah, so I’m gonna pump that to DSAM, if there’s a standard consent that the state uses, or that the providers in the community use.
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Amy Shanahan: having… having copies of blank consents at your fingertips would be helpful, so DSAM might be able to help you with that part, so good…
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Sherry Szczuka: So we… yeah, so Amy, thanks for that. We do not have a standard form.
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Amy Shanahan: Okay.
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Sherry Szczuka: we allow providers to sort of create their own, make their own. If they need guidance with that, we’d be more than glad to set them up with additional TA for that.
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Amy Shanahan: Okay?
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Sherry Szczuka: First, we don’t want it to be a DSAM form. Right. We want it to be their form.
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Amy Shanahan: Well, and the important things, and maybe another idea, Dawn and others, you might be able to get consents from the… maybe some providers in the community that you already work with. I know that as a provider, I had to have
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Amy Shanahan: a form that followed the SAMHSA, requirements, so, they are specific, but, having some level of assigned…
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Amy Shanahan: Okay, that I could talk to this organization. And I could say that the agency is going to have that person sign a consent, but it just tightens it up a little bit if you have it already for you, so that you could follow up and call the provider. So that might be an option to consider as well.
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Amy Shanahan: Share… having a provider share theirs, yeah.
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Amy Shanahan: And just some resources here, your local addiction technology transfer center, it has an opportunity for other resources, as well as SAMHSA’s hotline. They have a fine treatment, so the finetreatment.gov is
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Amy Shanahan: There for you as well.
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Amy Shanahan: And I know DSAM will probably have the list of their providers as well.
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Amy Shanahan: In the area?
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Amy Shanahan: And I will… Alright.
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Amy Shanahan: Just a little closing comment.
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Amy Shanahan: See if there’s any questions you have about anything.
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Amy Shanahan: So, to date, you’ve been through…
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Amy Shanahan: Fast Track SBIRT, besides the online module, talking here, some of you have reached out for technical assistance.
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Amy Shanahan: Just wondering, and here’s just a map of your ATTC. Your region is Central East at the Donya Institute. They’re housed out of,
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Amy Shanahan: Maryland?
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Amy Shanahan: But they serve Delaware, Virginia, West Virginia, I think.
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Amy Shanahan: This might be an old map.
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Amy Shanahan: But they serve you, so that’s what’s important.
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Amy Shanahan: And any other questions about everything related to SBIRT, before I hand the mic over to DSAMP.
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Sherry Szczuka: And as we always like to say, should you have questions that pop up, or you’re thinking of, reach out to your program integrity specialist. They can be your point of contact, and should be. Don’t feel you need to wait for our next session to do something.
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Amy Shanahan: All right.
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Amy Shanahan: Well, thanks, folks, I’m gonna… Hop off to a…
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Amy Shanahan: Another commitment, and DSAM will take it away, and I’m here in the background. Victoria will help set up anything if you want, anything from me, anything Espert. Thank you, Terry, so much. Thanks, folks. Thanks for contributing.
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Amy Shanahan: Yeah.
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Sherry Szczuka: Thank you.
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Victoria Pauline, (she/her) | BBS: B.
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Amy Shanahan: Bye now.