MISPARC Flow Staff Training: Rationale and Scripting

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Behavioral Health Integration (BHI) Activity Rationale - why do we do this?

All patients age 18 and over are given a BHI screen once a year that screens for alcohol using the AUDIT-C or other customize tool that may contain other components i.e; other drug use or depression PHQ9

  • Each of these conditions affects a person's overall health.
  • By using this screening tool, the clinician can better take care of the whole patient.

MA or Front Desk Staff enters BHI screen results into EHR or presents the paper screener results to the clinician before they see the patient

  • Direct data entry allows immediate access to the screening results and if the screens are positive, will trigger more questionnaires that need to be completed prior to the patient's appointment.

Follow-up on positive alcohol screen (AUDIT-C) MA or Front Desk staff review AUDIT-C for positive score

Low Positive AUDIT-C total score: 3-6 (women), 4-6 (men)

MA or Front Desk staff clips alcohol brochure to BHI paper screener or chart that goes to provider

  • Alcohol Brochure can be given to patient and supports preventive counseling for positive alcohol scores of up to 7
  • At these scores patient may be at risk for some health problems due to alcohol use
  • It does not mean the patient has a diagnosis of Alcohol Use Disorder, what we used to call “alcoholism”
  • The clinician will offer preventive counseling with the brochure including advice to drink below recommended limits and feedback about how alcohol affects patient's health
Positive AUDIT-C score: 7 or more for anyone

MA or other designated staff gives patient the alcohol symptom checklist The clinician will review the symptom checklist and start a discussion with the patient. If the patient is interested, they may connect them with a social worker, BHS, an alcohol treatment program, or AA.

  • Symptom checklist checks for possible alcohol use disorders for those patients who score between 7-12
  • The risk of alcohol harming health increases as AUDIT-C score increases.
  • How much someone drinks does not indicate a diagnosis of alcohol use disorders (what we used to call “alcoholism”)
  • The alcohol symptom checklist is used by the clinician to make a diagnosis of alcohol use disorders

MISPARC Flow Staff Training: Scripting

We have developed a few ways to introduce the BHI screen as well as the other assessments you would be asking the patient to fill out.

Writing down what you will say and then practicing it makes the experience comfortable for you and the patient. Feel free to adapt the scripts we have provided for you.

Managing awkward moments and scripts:
  • Introducing the BHI screen
  • Anxious patients or sick patients - encourage to complete as information is important to their care
  • Elderly patients: Dementia - do not give if diagnosis in chart
    • Caregivers with elderly patients - still give to the patient and patient can ask caregiver if they need help
    • If need MA to read screen, read questions/answers verbatim
  • “We are starting to screen all patients every year on conditions that affect your health. Could you fill this out for me?”
  • “Once a year, all our patients are asked to complete this form to see what could be affecting your health. Could you fill this out while I open your charts?”
Alcohol and Drug Use Symptom Checklists:
  • “To help you and your provider understand how your alcohol/marijuana/drug use might be affecting your health, would you please fill out this form for your provider?”
  • “Some patients who use alcohol/marijuana/drugs are not experiencing problems due to their use, but others may be having problems. To help our doctors understand any problems you may be experiencing we ask everyone who uses alcohol regularly/marijuana daily/drugs to complete this form as well.”
  • “Our doctors like to know what problems, if any, you might be experiencing due to your alcohol/marijuana/drug use. Would you mind filling out this form for him/her?”