Screening, Brief Intervention & Referral to Treatment

Screening, Brief Intervention and Referral to Treatment (SBIRT) is an evidence-based behavioral health intervention program. The OPCA SBIRT Initiative deploys non-licensed health educators who are trained in Motivational Interviewing to provide screening and brief interventions to patients who screen positive for behavioral risk factors. These health educators are provided with extensive training in Motivational Interviewing, implementation and workflow prior to clinic adoption. The primary goals of this pilot are to implement universal screening and brief interventions in CHC primary care clinics using a team-based and health educator-centered approach, to increase the number of adult patients being screened for risky drug and alcohol use, and to reduce the symptoms of substance use experienced by health center patients.

Universal screening is used “to identify, reduce, and prevent problematic use, abuse and dependence on alcohol and illicit drugs[1]”. In recent years, Oregon has been among the top ten states for several measures of illicit drug use, including past-month illicit drug use among people older than 12 and illicit drug dependence among people older than 12. Oregon has also suffered from a higher than national average rate of drug-induced deaths.[2] Behavioral health is a crucial component of high quality health care and foundational for improving patient health outcomes. Of the 311,300 patients seen in Oregon CHCs in 2012 (HRSA data), only 7,114, or roughly two percent, of patients received substance abuse services. Untreated addiction and risky substance use can cause or worsen illnesses of many kinds, including cardiovascular and pulmonary disease, cancer, mental health conditions[3] and diabetes[4]. SBIRT provides an opportunity to give patients a higher quality of care and to address issues that impact overall health. Furthermore, evidence shows that SBIRT dramatically saves future health care costs associated with substance use and abuse.[5]


[1] Substance Abuse and Mental Health Services Administration. Key features of risk and protective factors.  Retrieved from:

[2]Executive Office of the President of the United States. (2010) Oregon Drug Control Update. Retrieved from:

[3] Center on Addiction and Substance Use Columbia University.  Untreated addiction and risky use. Retrieved from:

[4] Leung, G., Zhang, J., Lin, W., Clark, R.  (2011). Behavioral disorders and diabetes-related outcomes among Massachussets Medicare and Medicaid beneficiaries.  Psychiatric Services, 62(6). Retrieved from:

[5] Substance Abuse and Mental Health Services Administration and Health Resources and Services Administration



OPCA started an SBIRT pilot program in 2013. In the first year, five clinics were involved; Northwest Human Services, Native American Rehabilitation Association, Old Town Clinic, Mosaic Medical and Virginia Garcia Memorial Health Center. Clinics received intensive training in Motivational Interviewing, workflow optimization, billing and quality improvement to promote effective SBIRT optimization. OPCA is proud of the strong performance of the clinics in the first year, when they screened over 4000 patients between July 2013 and January 2014. In year two OPCA worked with Wallace Medical Concern, Tillamook County Health Department and Centers for Family Health, La Clinica, Northwest Human Services, Native American Rehabilitation Association and Old Town Clinic to train more health educators and further the work around implementation and quality improvement.
Many lessons were learned from each of the participating clinics. OPCA has been working with its partners to create an implementation guide to assist other clinics across Oregon. The guide is now complete and available for download here.

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Contact Sarah Dryfoos with any questions or to get more information about the initiative.


Check out our SBIRT Resources!

SAMHSA SBIRT information

Behavioral Health Treatment Service Locator

Guidance on SBIRT coding

CMS SBIRT guidance