Screening, Brief Intervention, and Referral to Treatment (SBIRT)

A culturally adapted version of eCHECKUP TO GO, an intervention to reduce alcohol exposed pregnancies.

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This was a culturally tailored Screening, Brief Intervention and Referral to Treatment (SBIRT) intervention, for Native women of childbearing age. eCHECKUP TO GO, an evidence-based personalized and interactive intervention, was adapted based on focus groups and interviews with the community. After baseline assessment, participants were randomly assigned to the web-based intervention or treatment as usual. The 20-minute on-line intervention consisted of individualized feedback on the participant’s risk for alcohol-exposed pregnancy, the impact of alcohol on a fetus, physical and financial costs of alcohol, and how their drinking compared to other Native women’s use of alcohol. Treatment as usual consisted of access to educational brochures only. All participants had access to treatment referrals.

Outcomes

Estimates of changes or differences in alcohol-related problems and the stability of those changes or differences. 

Medium/Mixed Level of Change

All participants reduced drinking and risk for alcohol-exposed pregnancy; women with depression in the intervention group reduced risky behavior more than women with depression in the control group. 

The first report (Montag 2015a) informed that both intervention and control groups significantly reduced their drinking and risk for alcohol-exposed pregnancy. There was no additional benefit of being assigned to the intervention group over assessment alone. When the data were reanalyzed after separating participants screening positive and negative for depression (Montag 2015b), it was found that women with depression in the intervention group reduced drinking significantly more than women with depression in the control group.

Costs

Two domains estimating start-up and ongoing expenses. 

Medium start-up costs followed by lower ongoing costs. 

Local adaptation and development of web materials, information technology (IT) setup, and maintenance are required. Start-up costs for web-based interventions tend to be moderately high, including several highly-qualified staff members to develop a web interface for an intervention. Once developed, limited staffing is needed beyond community members to administer baseline assessment and referrals, and IT maintenance is needed.

Cultural Engagement

Two indicators of cultural and Tribal/community contributions. 

Intervention was culturally modified by local community members; research was conducted in partnership with Tribes. 

Focus groups with community members were employed (see Gorman et al., 2013) to culturally adapt the SBIRT intervention. Native images and videos of AI/AN mothers of children with fetal alcohol spectrum disorders (FASD) were included to provide a personal narrative element as an important component of the intervention. The research was prioritized by the Tribal Board, approved by the Tribal Institutional Review Board, and conducted as part of a community-university partnership.

Native women were recruited at two reservation-based clinics and one urban AI/AN health clinic in Southern California. 

Two hundred sixty-three (263) non-pregnant Native American participants of childbearing age (mean 28.6; range 18-45) were recruited from three Southern California AI/AN health clinics located in reservation and urban locations.

Staffing Needs

Credentials and/or background of personnel who delivered the intervention. 

Community Member

Community members interfaced with community women and a computer specialist for web-based intervention. 

This SBIRT prevention intervention requires community members to tailor the web-based intervention for their local community. Someone with computer skills is needed to modify the web-based system. Once the web-based intervention is developed, community-based staff are required to administer the baseline assessment and provide referrals.

Research Design

Methods employed to gather research data. 

Randomized controlled experimental design

Developmental stage of research

Stage of development of the evidence supporting this intervention. 

Early Stage

Feasibility, acceptability, and efficacy among a subgroup of participants is demonstrated. 

This web-based intervention appears potentially effective for a subgroup of AI/AN women experiencing depression but not for all AI/AN women in general. The assessment at baseline proved as effective as the intervention at reducing risk. Strong study design, high retention, and substantial reduction of risk show promise. Feasibility and acceptability are demonstrated.

Potential

Narrative offered by expert reviewers providing overall comments or evaluations about the intervention. 

This culturally adapted SBIRT intervention shows potential for efficacy and transportability to other Native communities. 

While this web-based adaption of SBIRT is transportable and feasible, it is unclear if it is more effective than assessment only or why it displayed modest effects among AI/AN women with depression. This intervention could be utilized in Indian Health Services clinics but would have to be modified to different regions for cultural appropriateness. It is noteworthy that participating in an assessment that focuses on drinking (without intervention but with referral to treatment) may be sufficient to decrease risky drinking-based vulnerability to alcohol-exposed pregnancy.

References

Primary 

Montag AC, Brodine SK, Alcaraz JE, et al. Preventing alcohol-exposed pregnancy among an American Indian/Alaska Native population: Effect of a screening, brief intervention, and referral to treatment intervention. Alcohol Clin Exp Res. 2015a;39(1):126-135. http://onlinelibrary.wiley.com/doi/10.1111/acer.12607/full . https://doi.org/10.1111/acer.12607 .

Secondary 

Montag AC, Brodine SK, Alcaraz JE, et al. Effect of depression on risky drinking and response to a screening, brief intervention, and referral to treatment intervention. Am J Public Health. 2015b;105(8):1572-1576. https://www.ncbi.nlm.nih.gov/pubmed/26066915 . https://doi.org/10.2105/ajph.2015.302688 .

Associated 

Gorman JR, Clapp JD, Calac D, Kolander C, Nyquist C, Chambers CD. Creating a culturally appropriate web-based behavioral intervention for American Indian/Alaska Native women in Southern California: The healthy women healthy Native nation study. Am Indian Alsk Native Ment Health Res . 2013;20(1):1-15. https://www.ncbi.nlm.nih.gov/pubmed/23529767 . https://doi.org/10.5820/aian.2001.2013.1 .

Counseling & Psychological Services (San Diego State University). eCHECKUP TO GO website. No date. https://echeckuptogo.com .

See references for all interventions 

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