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Table 2 Implementation Strategies and Categories

From: Strategies to promote the implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) in healthcare settings: a scoping review

   Use evaluative and iterative strategies Provide interactive assistance Adapt and tailor to context Develop stakeholder interrelationships Train and educate stakeholders Support clinicians Engage consumers Utilize Financial Strategies Change infrastructure
Article Implementation Strategies Implementation Strategy Categories
Anderson et al., 2016 [43] Conducted one (10–30 min) telephone support call (Groups 2, 5, 6, 8)   x        
Offered an option to refer patients to an online brief intervention as an alternative to face-to-face
intervention (Groups 4, 6, 7, 8)
   x       
Distributed educational materials (Groups 1, 2, 4, 5, 6, 7, 8)
Asked providers to screen patients (Groups 1, 2, 4, 5, 6, 7, 8)
Provided two (1–2 h) in-person trainings (Groups 2, 5, 6, 8)
     x     
Provided financial reimbursement for screening and advice activities (Groups 3, 5, 7, 8)         x  
Provided a record sheet to document SBIRT (Groups 1, 2, 4, 5, 6, 7, 8)          x
Bendsten et al., 2016 [45] Conducted one (10–30 min) telephone support call (Groups 2, 5, 6, 8)   x        
Offered an option to refer patients to an online brief intervention as an alternative to face-to-face
intervention (Groups 4, 6, 7, 8)
   x       
Distributed educational materials (Groups 1, 2, 4, 5, 6, 7, 8)
Asked providers to screen patients (Groups 1, 2, 4, 5, 6, 7, 8)
Provided two (1–2 h) in-person trainings (Groups 2, 5, 6, 8)
     x     
Provided financial reimbursement for screening and advice activities (Groups 3, 5, 7, 8)         x  
Provided a record sheet to document SBIRT (Groups 1, 2, 4, 5, 6, 7, 8)          x
Bernstein et al., 2007 [51] Provided technical assistance
Facilitated learning of individual clinicians
  x        
Tailored brief intervention and referral resources to meet local needs    x       
Partnered with research team and other stakeholders at each site     x      
Provided one (2-h) interactive workshop or a web-based learning module
Developed and distributed educational materials
     x     
Collaborated with volunteers from Alcoholics Anonymous        x   
Egizio et al., 2019 [50] Provided monthly implementation support
Facilitated clinical supervision
  x        
Tailored plan to address limited training and clinical supervision for SBIRT    x       
Identified champions (i.e., field supervisors) and partnered with instructors     x      
Provided one (1-day) training for field supervisors      x     
Received grant to develop SBIRT certificate program         x  
Henihan et al., 2016 [44] Partnered with the research assistant who conducted practice visits     x      
Distributed training and educational materials
Demonstrated intervention implementation
Provided educational support after the workshop
     x     
Lapham et al., 2012 [49] Monitored quarterly facility-level reports x         
Disseminated clinical reminders via the electronic medical records       x    
Linked performance measure to financial incentives for clinical leaders         x  
Created a national performance measure for a brief intervention for patients with alcohol misuse          x
Lindholm et al., 2010 [34] Completed pilot tests before wide-scale implementation x         
Developed a team of representatives from healthcare system (including a physician champion) and a university-based tobacco dependence research center     x      
Provided one (20-min) onsite training and an additional visit if needed      x     
Listed interventions in the electronic medical record if patient indicated an interest in quitting       x    
Modified the electronic medical record to improve identification and treatment of tobacco use          x
Mello et al., 2009 [42] Adapted plan to community emergency department environment (Phase 1)
Continued ongoing exploration and adaptation (Phases 1, 2)
   x       
Met with stakeholders to obtain feedback on intervention and implementation plan (Phase 1)     x      
Provided one (5-min) initial training of staff (Phase 2)
Provided small laminated reference cards (Phase 2)
     x     
Partnered with the research assistant, who provided the brief intervention (Phase 2)       x    
Mello et al., 2013 [35] Assessed for readiness and created an SBIRT policy (Adoption phase) x         
Facilitated monthly conference calls (Adoption and implementation phases)
Hosted a web site for technical assistance (Adoption and implementation phases)
  x        
Identified and prepared site leaders (Adoption phase)     x      
Provided online curriculum and in-person workshop (Adoption phase)
Provided another in-person workshop and webinar on the brief intervention (Implementation phase)
     x     
Mertens et al., 2015 [46] Reviewed quality feedback reports and addressed challenges (Arms 1 and 2)
Emailed quarterly reports of SBIRT rates to each clinic (Arms 1 and 2)
x         
Provided in-person technical assistance and facilitation (Arms 1 and 2)   x        
Provided one (2-h) initial training and one (30-min) booster training (Arms 1 and 2)
Posted educational videos on intranet site (Arms 1 and 2)
Provided one (1-h) training for medical assistants (Arm 2)
Provided an on-demand 30-min webinar session (Arm 3)
     x     
Obtained public support from leaders (Arms 1 and 2)
Directed the medical assistants to use the tool (Arm 2)
Added screening questions to the electronic health record to facilitate SBIRT (Arms 1, 2, 3)
         x
Muench et al., 2015 [36] Adapted the process to the workflow at each site    x       
Designated champions at each site     x      
Provided one (3.5-h) training for residents and shorter training for faculty physicians and clinic staff      x     
Created reminders in the electronic health record to alert clinicians       x    
Received funding from the Substance Abuse and Mental Health Services Administration         x  
Created documentation flow sheets in the electronic health record          x
Rieckmann et al., 2018 [37] Identified champions     x      
Developed the workforce      x     
Selected screening and brief intervention as incentive metrics
Aligned incentives
        x  
Redesigned workflow          x
Salvalaggio et al., 2015 [47] Completed a baseline needs assessment x         
Used a web platform to centralize materials
Provided implementation support
  x        
Toured other sites
Identified champions
    x      
Provided one (2–3 h) workshop
Distributed educational materials
Provided online modules and links to resources
     x     
Provided point-of-care tools to remind clinicians of SBIRT and available resources       x    
Partnered with community members with lived experiences, who discussed scenarios and answered questions during workshops        x   
Sharifi et al., 2014 [41] Completed a baseline needs assessment x         
Provided one (15-min) training session      x     
Embedded a reminder and decision support tool in the electronic medical record
Simplified the education and referral process
      x    
Sterling et al., 2015 [48] Provided feedback on rates of screening and referral each quarter and reviewed protocol and skills to promote use of SBIRT (Arms 1, 2) x         
  Provided technical assistance and clinical consultation (Arms 1, 2)   x        
  Provided three (60-min) training sessions (Arm 1)
Provided one (60-min) training session (Arm 2)
     x     
  Shifted tasks of brief intervention and referral to treatment to the behavioral health care practitioner when indicated (Arm 2)
Informed pediatricians of tools in the electronic medical records (Arms 1, 2, 3)
Reminded pediatricians to document clinical activities (Arms 1, 2, 3)
      x    
Thomas et al., 2016 [38] Presented data monthly x         
Tailored implementation strategies based on identified barriers    x       
Assembled an interdisciplinary SBIRT committee that met monthly
Identified an SBIRT champion
    x      
Provided brief in-service training meetings      x     
Designated SBIRT health education specialist to screen all patients and contact trauma resident daily       x    
Received funding from the Substance Abuse and Mental Health Services Administration         x  
Integrated an order for an SBIRT consult into the trauma order set          x
Whitty et al., 2015 [39] Adapted the implementation approach and training materials to the local setting and Indigenous population    x       
Developed resources in collaboration with consultants and other experts     x      
Developed best practice pathway and other resources
Provided six (1-h) workshops
     x     
Collaborated with an Indigenous reference group to develop the resources        x   
Zimmermann et al., 2018 [40] Reported status updates at monthly meetings x         
Assembled a multidisciplinary team and developed a process for SBIRT     x      
Provided one (4-h) training for social workers
Provided an in-service to all key staff
     x     
Disseminated a list of eligible patients daily and kept this list in a project binder       x