HAVEN Free Clinic launches program to screen patients for alcohol and drug use

The student-run HAVEN Free Clinic has launched a new program that screens patients for alcohol and drug use, and refers them to treatment for risky behavior.

Funded by an APA Foundation Helping Hands grant, the project is called Screening, Brief Intervention, and Referral to Treatment (SBIRT). It has been implemented at health care facilities nationwide as practitioners seek to identify, reduce and prevent the use, abuse and dependence on alcohol and illicit drugs.

The program started at HAVEN in November, said Juan Rodriguez Guzman, a Yale medical student and clinical advisor at HAVEN.

Rodriguez Guzman and the students who volunteer at HAVEN sought and were awarded funding to expand SBIRT to the clinic, which primarily serves Spanish speaking, uninsured and undocumented immigrants.

The clinic provides a range of primary care services, including psychiatry, and is partially funded by Yale. It is run out of the Fair Haven Community Center in New Haven, and sees patients on Saturday mornings.

It is unique in that it allows students across the disciplines of medicine, nursing, physician’s associates and public health to work with patients.

The students decided to launch SBIRT after seeing large numbers of alcohol and drug users visiting the clinic for other medical problems.

Those patients now sit with a student practitioner for up to 15 minutes to talk about their social habits, Rodriguez Guzman said. Practitioners employ a principle called “motivational interviewing,” an evidence-based counseling technique that uses empathy, positive framing, reflective listening and gentle education to encourage people to change their habits.

During the conversation, a patient’s alcohol and drug use is documented, and the practitioner speaks to the patient about their risky behavior and provides advice.

The patient is then referred to treatment at facilities like the Connecticut Mental Health Center and the Hispanic Clinic. Once in treatment, patients are charged on a sliding scale, although no one is denied services because of an inability to pay.

Rodriguez Guzman said the screening in many cases is the first time a patient has opened up to someone about their addiction.

It’s becoming a really good recruiting tool for psychiatry. Here they (student practitioners) get that hands on experience to sit with a patient and deal with their issues.

Andres Barkil-Oteo, MD, MSc, Assistant Professor of Psychiatry and faculty advisor at the HAVEN Free Clinic

“People are extremely grateful once you offer them these services,” he said.

Student practitioners expect to track patients for three to four months, and then will get feedback about their progress in treatment.

HAVEN has become a model for the use of mental health interventions at a student-run clinic. The facility has been operating for 10 years, but the Behavioral Health Program began in 2012.

Faculty advisors Michelle Silva, PsyD, Assistant Professor of Psychiatry; and Andres Barkil-Oteo, MD, MSc, Assistant Professor of Psychiatry, hope Yale’s SBIRT program can be copied and implemented elsewhere.

“I think it’s important to emphasize this is student driven and run,” Silva said. “I see it as a really great training experience for the students.”

Barkil-Oteo agreed.

“It’s becoming a really good recruiting tool for psychiatry,” he said. “Here they (student practitioners) get that hands on experience to sit with a patient and deal with their issues.”

Third- and fourth-year medical students supervise the first-year students, and that helps both groups with their training, Barkil-Oteo said.

He said patient assessment skills improve because students get to practice what they learn in class.

“This is training in action about how to think and deal with an underserved population,” he said.

Like the other student practitioners at HAVEN, Rodriguez Guzman is not paid for his work, but said he enjoys volunteering because he likes to help people and is improving his training.

The experience has reinforced his decision to pursue a career in psychiatry. He said he never considered psychiatry before being exposed to it at Yale, but that he finds it rewarding and wants to continue his studies.

This article was submitted by Christopher S Gardner on December 15, 2015.

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Andres Barkil-Oteo

Assistant Clinical Professor of Psychiatry

Michelle A Silva

Assistant Professor of Psychiatry