Screening, Brief Intervention, and Referral to Treatment (SBIRT)
SBIRT-VA was developed to identify substance abuse problems among veterans applying for disability compensation for PTSD. SBIRT-VA involves assessing substance use and other risky behaviors and briefly counseling the veterans to participate in the appropriate level of care. It involves a brief intervention tailored to the veteran's level of substance use, focused on increasing insight into the role of substance use, fostering motivation to make behavioral changes, and accepting a referral to treatment. A key aspect of SBIRT is the addition of screening and VA treatment into the existing VA system for conducting Compensation examinations. SBIRT-VA provides early intervention for at-risk veterans before more severe consequences occur.
The therapist uses Motivational Interviewing methods to encourage veterans to engage in treatment. As prescribed in Motivational Interviewing, the therapist adopts a supportive, empathic stance to help veterans explore ambivalence about treatment. SBIRT-VA consists of one 60-minute intervention session conducted at the VA after the veteran has completed the Compensation and Pension evaluation. At the veteran's request, the therapist will be available for a phone session and/or repeat visit, but the focus of the intervention is on facilitating transition to treatment.
Screening, Brief Intervention and Referral to Treatment with Pain-Management advice (SBIRT-PM) adapts traditional SBIRT by targeting both pain and substance use. It begins with a pain management portion to address the Veteran's presenting complaint by explaining that pain management involves trying to improve overall functioning using physical and psychological approaches. The counselor asks the Veteran which conditions he/she has filed a disability claim for and explains VA resources available for these conditions generally and for pain management specifically. Then, as part of the combined physical and psychological appraisal, standard SBIRT is conducted. SBIRT-PM will be delivered using the Motivational Interviewing stance and techniques typical of SBIRT. Capitalizing on Veterans’ goal of relief from pain, SBIRT-PM fosters Veterans’ motivation to change and reduce substance use. SBIRT-PM’s efficacy is supported by a completed clinical trial of 101 Veterans applying for service-connection for Musculoskeletal Disorders (MSD). A telephone version of SBIRT-PM is currently being tested in a two phase, randomized controlled trial.
Rosen, M. I., Becker, W. C., Black, A. C., Martino, S., Edens, E. L., & Kerns, R. D. (2019). Brief Counseling for Veterans with Musculoskeletal Disorder, Risky Substance Use, and Service Connection Claims. Pain Med, 20(3), 528-542. doi:10.1093/pm/pny071
Meshberg-Cohen S, DeViva JC, Rosen MI: Counseling Veterans who are applying for service-connection status for mental health conditions. Psychiatric Services. Published online.
Sakr CJ, Black AC, Slade MD, Rosen MI: Iraq/Afghanistan-era Veterans with Back Pain: Characteristics and Predictors of Compensation and Pension Award. Journal of Rehabilitation Research & Development 2016; 53(6): 659–668
Marx BP, Wolf EJ, Cornette MM, Schnurr PP, Rosen, MI, Friedman MJ, Keane TM, Speroff T: Using the WHODAS 2.0 to assess functioning among veterans seeking compensation for posttraumatic stress disorder. Psychiatric Services 2015; 66: 1312-1317
Rosen MI, Afshartous D, Nwosu S, Scott MD, Jackson JC, Marx BP, Murdoch MM, Sinnot PL, Speroff T: Racial Differences in Veterans’ Satisfaction with Examination of Disability from Posttraumatic Stress Disorder. Psychiatric Services. 2013; 64 (4): 354–359. doi: 10.1176/appi.ps.201100526 PMID: 23318842
McQuaid JR, Marx BP, Rosen MI, Bufka LF, Tenhula W, Cook H, Keane TM: Mental Health Assessment in Rehabilitation Research. Journal of Rehabilitation Research and Development 2012; 49: 121-138
Rosen MI: Compensation Examinations for PTSD—an Opportunity for Treatment? Journal of Rehabilitation Research and Development 2010; 47(5): 15-22. PMCID 3064070