AMHERST, Mass. - As recreational marijuana use becomes legal in Massachusetts, researchers at the University of Massachusetts Amherst College of Nursing are now training all student nurses in clinical techniques proven to be effective in speaking to clients about risky health behaviors and in collaborating on interventions.
The technique, known as "screening, brief intervention and referral to treatment" or SBIRT, assists healthcare workers in identifying underlying signs of substance abuse and provides early opportunities to intervene with individuals having problems. As they graduate this semester, 44 student nurses who learned SBIRT skills in the classroom with national expert Dr. Paul Grossberg are now practicing the technique in their clinical practice settings across the region.
Donna Zucker, professor of nursing, says, "Every student nurse will get educated around addiction, risk appraisal, motivational interviewing and in using SBIRT every day in their careers. They go out as new professionals with skills that many people already in the field haven't learned yet. Our student nurses can also train people in settings wherever they end up. The first pioneers are going out and engaging the community now."
Students say that learning by practicing with real or simulated patients has made a difference in their communication. Senior nursing student Jennifer La, who served her clinical practice at University Health Services, says, "The new skill I learned was initiating conversation about a topic that can be sensitive or personal with a client, to learn more about their health."
Plans to add SBIRT training to the nursing curriculum at UMass Amherst began in July when the college received an $870,000 grant from the Substance Abuse Mental Health Services Administration, one of only 12 SBIRT training centers in the nation. The goal is to teach 150 student nurses here per year for the next three years in the technique, say Zucker and Sally Linowski, associate dean of students, off campus life and community education.
They are co-lead investigators in the SBIRT training with a team of College of Nursing, UMass Amherst School of Public Health and Health Sciences faculty, community members and a council of directors.
Zucker points out that nurses, who care for people every day at an intimate level in varied settings, are a natural for SBIRT interviewing that may lead to sharing information about the patient's health habits. "Nurses are the boots on the ground, they're the first person who might be asking this kind of question. And, nurses have a holistic approach. While they are taking a history, they are building rapport with the patient, building a relationship."
School nurses fill this role for young people, she adds. They talk about many health education issues such as nutrition, home safety, bullying and violence in addition to substance use. "The nurse may be the first on the scene. If a child's answers raise a flag, they report it to a superior who takes it from there."
The most challenging part of implementing SBIRT, the nurse educators say, is training health care providers to use a non-judgmental approach that motivational interviewing can support with patients. Zucker says that as part of their clinical rotations in UMass Amherst's nursing degree program, eight groups of eight senior nursing students each work in behavioral or mental health services, community clinics, hospitals, campus health services and other institutions across western Massachusetts and now all graduating seniors will have SBIRT skills.
The U.S. surgeon general recently reported that substance abuse is at crisis levels in the nation. Since the early 2000s, the U.S. Department of Health and Human Services has identified SBIRT as a best practice in educating the nation about how to screen for substance abuse and risk, Linowski says, "and UMass Amherst has established itself as a leader in SBIRT."
She adds, "Clinicians trained in motivational interviewing and behavior change theory help patients explore and resolve ambivalence to change and identify personal motivations and options for reducing harms or entering treatment. Only one in 10 people who need treatment get it, and SBIRT has been shown to help people identify their own motivations for seeking help."
With one in seven people developing substance abuse disorder in their lifetime, Linowski says, "Universal prevention is a tide that raises all boats. What we want is to identify what we as a society can do to make everyone healthier and identify where and when to talk to people. Addiction is not an individual problem, it is a progressive family disease and a pressing topic right now."