Implementing Screening, Brief Intervention, and Referral to Treatment in the Emergency Department: A Qualitative...

Emergency departments (EDs) serve as a critical point of care for individuals with unmet substance use disorder (SUD) treatment needs. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based approach designed to proactively identify and mitigate substance use risk. We sought the perspectives of individuals responsible for delivering ED-based SBIRT to better understand the impact on patients and ED processes and identify challenges in implementing SBIRT.

In-depth interviews were conducted with clinicians and supervisors (n = 9) involved in SBIRT delivery at 2 emergency departments in King County, Washington, United States. Thematic analysis was used.

ED-based SBIRT has benefits to patients as well as other providers. SBIRT leverages teachable moments following substance-related injuries and emphasizes patient autonomy to provide a form of substance use care that would not otherwise be available in the ED. There are ancillary benefits to the ED, including improved interprofessional collaboration, increased capacity for substance use care, and perceived destigmatization among other healthcare providers. Persistent resource constraints-including limited reimbursement for core components of SBIRT and lack of access to many treatment options-were identified as challenges to implementation.

Reliable referral networks, integration of immediate treatment access, and sustained investment in staff training are critical to maximizing the benefits of SBIRT programs. While gaps in the behavioral health continuum continue to present challenges, SBIRT remains a vital intervention for connecting patients to care and shaping ED practices toward improved SUD outcomes. These findings are relevant for individuals responsible for implementing similar programs as well as implementation-focused researchers.