Crucial conversations to empower the underserved: Integrating alcohol, drug and tobacco interventions into primary care.

Old Town Clinic (OTC) is a Federally Qualified Health Center in downtown Portland providing patient-centered, trauma-informed and integrated behavioral health and primary care to patients who are low-income and/or experiencing homelessness. OTC is part of Central City Concern (CCC), a social services agency whose mission is to provide pathways to self-sufficiency. Presenters will outline the regional and national policy influences that supported the implementation of a drug and alcohol-focused screening intervention. They will also share the context of how OTC has historically interacted with clients about behavior change related to substance use and smoking. Presenters will review some evidence supporting the value of SBIRT (Screening, Brief Intervention, and Referral to Treatment), while noting that very little data or literature exists on the use of SBIRT in homeless or underserved populations. Presenters will also share how expanded staffing has allowed OTC to widen its reach and scope to include tobacco cessation. Finally, presenters will review essential considerations in implementation of interventions related to alcohol, drug, and tobacco use through two lenses: that of the patient experience and that of EHR integration, workflow design, and quality improvement. Related to the patient experience, presenters will provide lessons learned for overcoming systemic and cultural barriers to having impactful conversations with patients experiencing homelessness about behavior change, including integrated alcohol, drug and tobacco treatment services. They will also share experiences using quality-focused interdisciplinary team to design workflows that allow for EMR integration, process and outcome measures, staff engagement, and improved patient access. The group discussion component will be presented in fishbowl format because it allows a large group of people to participate in one conversation. In this structure, five to six attendees (aka, “starter fishes") will sit in the center of the discussion (or in a panel format), and an open chair will be available for any volunteers. At any time, attendees can rotate through the open chair and engage in the conversation. Presenters hope to draw out the passion and interest of the attendees in a discussion of what makes for successful SBIRT-like interventions.