Over the last few weeks, I have spent a lot of time researching the utilization of SBIRT (Screening Brief Intervention Referral to Treatment) on college campuses and other institutions of higher education. The most common implementation is in the form of Medical Residency programs, which over the last 8 years have received tens of millions of dollars from private foundations and governmental entities (SAMHSA mostly). A mere fraction of those awarded funding of this type have gone to measures which I would consider above and beyond, and implemented SBIRT in a practical manner which truly benefits emerging adults. That isn’t to say that there are no entities providing this practical approach to SBIRT; SUNY Albany has won multiple awards for their STEPS program, and is a great program which brings SBIRT to scale for enrolled students (only for alcohol however); the University of Vermont is the first school to implement practical SBIRT for both substance use and mental health. There are a few others, and I applaud them for the foresight to implement SBIRT in this way: a way in which it is actually impacting individuals in a tangible and calculated manner. The problem with medical residency programs focused on SBIRTs is that, at least in my opinion, it isn’t working. After multiple conversations with various professionals and consumers across many geographic regions, SBIRT is not being implemented in primary health care settings. It would be important to state here that this is to be expected in primary care settings that are owned and operated by older practitioners, that would not have had access to these residency programs, but even in newer practices, SBIRT is not being utilized, not to scale.
While I hope to further expand on my concerns of practical implementation of SBIRT, this information was merely a set up to the juxtaposition of a similar problem, perhaps a much larger problem. Just as millions of dollars have been inserted into the curriculum development and practice dissemination of SBIRT, so has large scale funding been put into the same hopeful outcomes for peer recovery support services. With a 5 minute search on the internet one could find over 15 different peer recovery coach certifications and trainings, some accredited through single state health authorities, others not, some for profit and others not. Grants have been trickling down from the likes of SAMHSA and HRSA on a national level, and different state health service departments in various regions, all in the hopes to either develop peer support service training curriculums, or to merely increase the number of certified individuals that have completed said curriculums. However, it is much more challenging to find actual practical implementation of these services and resources, or the individuals trained to employ them. A search for employment opportunities, which utilize peer recovery support service providers, reveals a scant offering in most geographic regions of the country. I would estimate that we now have over 2,500 certified peer recovery support specialists (in different modalities) in this country, and most are not employed in peer recovery support specialist roles; not for the lack of trying, the jobs just have not been created. Most that exist are a conglomeration of roles, which can benefit from the implementation of peer recovery best practices in previously existing positions.
Just as with SBIRT, we are spending millions on creating training curriculums, and then even more on training individuals to be adequately prepared to provide these services. However, we have spent next to nothing on creating the capacity for these individuals to exist within the workforce. Under the premise of workforce creation, which I would say we have accomplished that task, these workers are trained, but have nowhere to go. Capacity has to be created if we are going to implement peer recovery support specialists in a practical way, or we will stay stuck in the SBIRT like stagnation of hundreds of trained professionals, with no where to practice their new skills.
I for one am a firm believer in both SBIRT and peer recovery support specialists; they are a valuable addition to the continuum of care in behavioral health which improves outcomes and overall quality of consumer life. We must begin to change the way we fund projects, both privately and through governmental agencies, and begin to create outlets for practical implementation rather than philosophical creation. Best practices are meant to be practiced, not just studied.