Qualitative reports of interventionists in the SMART-ED study: Challenges and themes.
Interventionists involved in the NIDA Clinical Trials Network “Screening Motivational Assessment and Referral to Treatment in Emergency Departments (SMART-ED)” protocol (CTN-0047) conducted 30-minute motivational enhancement therapy sessions with patients presenting to medical emergency departments (EDs) who screened positive for problematic substance use. Interventionists, working from a centralized call center, attempted to complete two 20-minute telephone “booster” sessions within a week following a patient’s ED discharge. The presentation presents brief interventionists’ and booster interventionists’ perspectives on the experience of providing brief interventions in a medical ED setting and over the phone. Following completion of the treatment phase of the study, brief and booster interventionists reported the unique challenges and lessons learned as part of their final supervision session and in discussions with the research team. We describe the rationale and format of intervention and booster sessions, and offer a qualitative perspective on the unique challenges, lessons learned, and themes that emerged. Themes emerging in the brief interventionists’ reports included: (1) Challenges of conducting SBIRT inherent in the nature of the ED, including patient flow, availability of space, frequent interruptions, privacy and confidentiality, and patient acuity. (2) Maintaining focus on addictions in the face of competing priorities, including medical reasons for ED visit and other psychosocial/mental health needs. (3) Using MI techniques appropriately during intervention, and not using them during screening and assessment. Themes from the booster interventionists’ reports included: (1) Difficulties reaching and engaging participants following their ED visits. (2) Differences in engaging individuals who viewed their ED visits as related or not to their drug use. (3) Differences in the perceived need and willingness to change behaviors between those whose primary drug is marijuana versus other classes of drugs.
Conclusions: There are many complexities involved in providing brief addiction intervention in the ED and in delivering a brief intervention over the phone.
Related protocols: CTN-0047