In the context of SBIRT, referral to treatment is short-hand for a well-planned process through which a healthcare professional provides an active referral to specialty treatment for patients who screen positive AND indicate a willingness/desire for such services during the brief intervention conversation. Whether the process includes internal behavioral health providers and/or external referral sources; an established relationship, referral protocol, and family involvement are key components.
Managing the referral process and ensuring that the patient receives the necessary chronic disease management and follow-up support is critical to the recovery process.
Internal Behavioral Health Providers
Practices in which behavioral health practitioners are available on-site through co-located or integrated service provision can create a flow that incorporates a warm handoff. This approach includes a physical introduction provider to provider and increases the likelihood of participation in further assessment, motivational counseling, or brief treatment. In some cases, a treatment option that is not available on-site will be necessary and the patient is then referred to a higher level of care. Depending on flow decisions, integrated behavioral health staff may also be responsible for such external referrals to specialty care.
Below is an example of a clinic workflow that includes a warm handoff. The video was created by SBIRT Oregon:
External Substance Use Disorder Specialists
Established Relationships and Protocols
In order for the referral to external specialty care to be efficient and successful, primary care practices must initially establish and cultivate relationships with specialty providers for all levels of care. Release of information mechanisms should be established to confidentially share and receive pertinent patient information with the referral provider prior to the need to refer a patient.
Parent and Family Involvement
It is important to note that many youth with a severe substance use disorder know that there is a problem and accept a referral to treatment. Parents are often already concerned about the problematic drug or alcohol use and therefore youth are often open to involving their parents in the conversation without further motivational conversation on the part of the provider. Parent involvement is crucial as patients with family involvement have better treatment outcomes. Read more in our Parent one-pager.
Levels of Care
Substance use disorders treatment includes services at different levels of care appropriate to the particular patient’s diagnosis and circumstances.
The majority of patients requiring specialty care for a substance use disorder can be effectively provided treatment through services they participate in while remaining at home, in their own community.
Outpatient Services (Individual, Group)
Intensive Outpatient Services (IOP)
Opioid Treatment Programs (Methadone prescribing/dispensing)
Office Based Medication Assisted Treatment (Buprenorphine/Suboxone prescribing/dispensing)
Patients with the severe substance use disorder diagnoses may be assessed as requiring the highest levels of care.
Medically Managed Inpatient Hospital-Based Services
Access to Specialty Care
In New Hampshire it must be recognized that timely access to the higher levels of care for severe substance use disorders can be difficult, particularly for adolescents. The need to expanding treatment capacity for substance use disorders has been widely recognized and there are many efforts underway to expand access to specialty substance use disorder care. This has been facilitated by the inclusion of specific provisions in the Affordable Care Act such as the essential health benefits inclusion of mental health and substance use disorders care. These and other changes in the healthcare landscape in New Hampshire are creating an environment in which treatment access is expanding.
A recent assessment was conducted by Community Health Institute/NH Center for Excellence to better understand the capacity of practitioners and service delivery systems in New Hampshire to identify, treat, and support recovery from substance use disorders. The data provided in this report provides a point-in-time synopsis and geographic distribution of practitioners, service providers, service delivery systems, existing capacity, anticipated capacity, and the challenges and limitations with delivering substance use disorder services. The full report can be accessed on the Center website at www.nhcenterforexcellence.org. Using the organization and independent practitioner contact information received, an online resource directory of existing substance use disorder services across NH will be created. This directory will be accessible to NH providers and residents with the ability to search for treatment options by location and service type.