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White Paper: Start-Up Costs of SBIRT Implementation for Adolescents in Urban U.S. Federally Qualified Health Centers

May 13, 2018 | White Papers and Studies

This white paper “Start-Up Costs of SBIRT Implementation for Adolescents in Urban U.S. Federally Qualified Health Centers” was authored by RTI International; RTI International, Research, Friends Research Institute; Total Health Care; Mosaic Group; Department of Psychology, University of Maryland, College Park. It was published in the Journal of Studies on Alcohol and Drugs in May 2018.


Objective: Understanding the costs to implement Screening, Brief Intervention, and Referral to Treatment (SBIRT) for adolescent substance use in primary care settings is important for providers in planning for services and for decision makers considering dissemination and widespread implementation of SBIRT. We estimated the start-up costs of two models of SBIRT for adolescents in a multisite U.S. Federally Qualified Health Center (FQHC). In both models, screening was performed by a medical assistant, but models differed on delivery of brief intervention, with brief intervention delivered by a primary care provider in the generalist model and a behavioral health specialist in the specialist model.

Method: SBIRT was implemented at seven clinics in a multisite, cluster randomized trial. SBIRT implementation costs were calculated using an activity-based costing methodology. Start-up activities were defined as (a) planning activities (e.g., changing existing electronic medical record system and tailoring service delivery protocols); and (b) initial staff training. Data collection instruments were developed to collect staff time spent in start-up activities and quantity of nonlabor resources used.

Results: The estimated average costs to implement SBIRT were $5,182 for the specialist model and $3,920 for the generalist model. Planning activities had the greatest impact on costs for both models. Overall, more resources were devoted to planning and training activities in specialist sites, making the specialist model costlier to implement.

Conclusions: The initial investment required to implement SBIRT should not be neglected. The level of resources necessary for initial implementation depends on the delivery model and its integration into current practice.

RTI International is an independent, nonprofit research institute dedicated to improving the human condition. Our vision is to address the world’s most critical problems with science-based solutions in pursuit of a better future. Clients rely on us to answer questions that demand an objective and multidisciplinary approach—one that integrates expertise across the social and laboratory sciences, engineering, and international development.

Friends Research Institute, located in Baltimore, Maryland, promotes health and well-being through research, grants administration, education and treatment.

Total Health Care is a Federally Qualified Health Center (FQHC) dedicated to caring for everyone in our community—especially those who are most in need. We care for more than 34,000 patients annually—nearly all of whom are at or below the 200% poverty line—at locations throughout Greater Baltimore.

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