Are We There Yet? A Review of Screening, Brief Intervention, and Referral to Treatment (SBIRT) Implementation...

Screening and brief intervention (SBI) for alcohol is an evidence-based prevention practice designed to reduce frequency and severity of alcohol misuse. Many studies have validated the effectiveness of SBI for reducing levels of alcohol misuse, especially in primary medical care. Additional research continues to be conducted in terms of the effectiveness of including referral to treatment (SBIRT) and addressing illicit drug use and prescription drug abuse. Importantly, cross-comparison among SBIRT programs is difficult because evaluative processes vary widely between programs, which themselves often are substantively different. In this brief report, we utilized cross-comparison techniques to elucidate similarities and differences among SBIRT fidelity tools and proficiency checklists. In early 2014, researchers completed a systematic review of SBIRT fidelity tools and proficiency checklists published or made available from 2004 through April 2014; in total, eleven instruments were located and assessed. The analytic methodology consisted of creating a matrix with key SBIRT components identified from the literature prior to assessment. Three researchers populated the matrix with the identified fidelity tools and proficiency checklists before assessing each tool for the presence or absence of each component. The level of agreement between the researchers was checked for inter-rater reliability using free-marginal Kappa statistics. The results of the matrix analysis suggested heterogeneity among existing SBIRT fidelity tools and proficiency checklists. Importantly, it was not the case that this lack of concordance reflected poorly on any given fidelity tool. Rather, it emphasized the multi-partite and variable nature of SBIRT programs. It was not evident that a single standardized SBIRT fidelity tool or proficiency checklist could appropriately determine the level of fidelity to SBIRT for all programs. Suggestions for next steps in SBIRT fidelity research are provided based on the output of the comparison matrix.