Researchers at the Boston University School of Public Health (BUSPH) have been awarded $750,000 -- the first award of a three-year grant -- from the Bureau of Substance Abuse Services at the Massachusetts Department of Public Health (DPH) to begin training the state's hospital emergency departments (EDs) in effective techniques to improve the care of patients at high risk of dependent drinking and substance abuse.

Massachusetts ranks second among all states in alcohol use among residents 12 years old and older, according to the 2004 National Survey on Drug Use and Health by the Substance Abuse & Mental Health Services Administration. In EDs across the state, patients suffering from alcohol-related illnesses and injuries are often treated and released without anyone identifying these problems, resulting in repeat visits for otherwise preventable conditions.

The BNI-ART Institute at the Boston University School of Public Health, which trains health care professionals in techniques to screen for and conduct brief negotiated interviews and referrals to treatment, will work in partnership with DPH and a broad variety of Massachusetts organizations representing health care professionals and the community at large, including the Massachusetts Emergency Nurses Association and the College of Emergency Physicians. (The BNI-ART acronym stands for Brief Negotiated Interview and Appropriate Referral to Treatment.) 

As part of the DPH grant, emergency departments at six hospitals in regions around the state will be selected to have their staffs trained in what is known as "Screening, Brief Intervention and Referral to Assessment or Treatment" (SBIRT) techniques. These brief motivational interventions in the emergency department, delivered as part of routine health care, have been shown to increase abstinence and reduce substance-related health and social consequences among emergency department patients.

A key aspect of the grant will allow EDs to hire health promotion advocates who will be trained to assist physicians and nurses, who have limited time to spend with patients or to facilitate substance abuse treatment when it is appropriate. "Identifying patients who have serious substance use issues in emergency departments and other health care settings and referring them to appropriate care is not only good for the patient but reduces demand for critical emergency services" said Paul Cote, Commissioner at the Massachusetts Department of Public Health.

The training project is led by a husband and wife research team, Edward Bernstein, MD, professor of emergency medicine at Boston University School of Medicine and professor of social and behavioral sciences at BUSPH, and his wife, Judith Bernstein, PhD, ADN, MSN, associate professor of maternal and child health at BUSPH. Together they lead the BNI-ART Institute, in affiliation with the Youth Alcohol Prevention Center at BUSPH, which is funded by the National Institute on Alcohol Abuse and Alcoholism. 

In the past decade, the couple has used innovative approaches of connecting ED patients with treatment services successfully at Boston Medical Center, public hospitals in New York City, and at 14 national demonstration sites for the National Institutes of Health. The techniques have improved the quality of care for patients and helped address problems of ED overcrowding and long waits for care.

"For too long Massachusetts' hospital emergency departments have lacked resources to address the needs of patients who present with substance abuse-related health problems," said Edward Bernstein, MD. "In six new sites, EDs will no longer miss this diagnosis, or be forced to 'treat and street 'or 'stitch and ditch' patients who would benefit from an intervention to help them change their alcohol or drug use."

The grant will support local teams from each of the selected hospitals to travel to Boston Medical Center for training. At a later stage in the program, BNI-ART Institute educators will travel to EDs at participating hospitals to provide on-site training to staff across shifts and clinical disciplines. The staff will also be trained to use tools to evaluate the effectiveness of SBIRT practice in each setting.