Variation in brief treatment for substance use disorder: a qualitative investigation of four federally qualified health centres with SBIRT services

Brief treatment (BT) or regular outpatient alcohol use or substance use disorder (SUD) treatment is a key element of the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model. It can be an effective, short-term, and low-cost treatment option for many people who misuse alcohol and drugs. Nevertheless, inconsistent BT implementation often costs similar to regular outpatient care. Prior research is also prevalent with inconsistent operationalizations regarding the measurement of BT received by patients. Therefore, there is a need to more explicitly identify and document variations in BT practice.

Qualitative interviews in four Federally Qualified Health Centres (FQHC) were undertaken as a sub study of a larger clinical trial. Researchers interviewed 12 staff including administrators and clinicians that are involved in BT supervision, referral, or provision within the four FQHCs. Data were analysed following an inductive approach guided by the primary research questions.

Four research questions guided data collection and analysis activities as per the below:

• Question 1: How is BT defined and structured within the participating FQHCs?
• Question 2: Which patients are appropriate for BT services?
• Question 3: How do the FQHCs ensure quality of BT services delivered?
• Question 4: Why do providers think some trial participants did not recognize having received BT?

Findings reveal substantial differences in how BT was conceptualized and implemented within the FQHCs. This included a variety of techniques in which BT was presented and described to patients that likely influences:

• How they perceive the BT they receive
• Not realizing they received substance use disorder treatment at all.

The findings raise questions regarding the validity of previous research, demonstrating more objective definitions of BT and fidelity checklists are needed to ensure reliability of outcomes. Future work in this area should seek to:

• Understand BT as practiced among a larger sample of providers,
• The direct experiences and perceptions of patients,
• The need for more consistent implementation,
• Guidelines for quality assurance,
• Standardized stage of change assessments to aid practitioners.