for Full Referral / Intervention Condition Pre-Screen Screen / Assessment Pre-Screen Age Group Risk Level Action Psycho-education; Motivational Med/High TAY Interviewing; Collaboration with MD; (>25) EMR; Referral/warm hand-off Psycho-education; Motivational Med /High trauma GAD-2 >3 PCL-C Adult Interviewing; Collaboration with MD; (>25) EMR; Referral/warm hand-off Psycho-education; Motivational Med/High Older Adult Interviewing; Collaboration with MD; (>25) EMR; Refer to UCI IMPACT Psycho-education; Motivational Med TAY Interviewing; Collaboration with MD; High EMR; Referral/warm hand-off Women- 3 Psycho-education; Motivational Men- 4 Med (8-19) alcohol AUDIT-C (3) AUDIT (10) Adult Interviewing; Collaboration with MD; (w/ 1+ pts from High (>20) EMR; Referral/warm hand-off Q’s #6 or 7) Psycho-education; Motivational Med (8-19) Older Adult Interviewing; Collaboration with MD; High (>20) EMR; Referral/warm hand-off Psycho-education; Motivational Med/High TAY Interviewing; Collaboration with MD; (>12) EMR; Referral/warm hand-off Psycho-education; Motivational other Med/High Dr. Saitz’s 1-Q YES DAST (28) Adult Interviewing; Collaboration with MD; drugs (>12) EMR; Referral/warm hand-off Psycho-education; Motivational Med/High Adult Interviewing; Collaboration with MD; (>12) EMR; Referral/warm hand-off Identify reporting requirements; Med/High Psycho-education; Motivational TAY (>1) Interviewing; Collaboration with MD; EMR; Referral/warm hand-off Identify reporting requirements; intimate Med/High Psycho-education; Motivational partner FWV 1-Q YES PVS (3) Adult (>1) Interviewing; Collaboration with MD; violence EMR; Referral/warm hand-off Identify reporting requirements; Med/High Psycho-education; Motivational Older Adult (>1) Interviewing; Collaboration with MD; EMR; Referral/warm hand-off
Condition Pre-Screen for Full Pre-Screen Screen / Assessment Referral / Intervention Age Group Risk Level Action trauma GAD-2 >3 PCL-C TAY Med/High (>25) Psycho-education; Motivational Interviewing; Collaboration with MD; EMR; Referral/warm hand-off Adult Med /High (>25) Psycho-education; Motivational Interviewing; Collaboration with MD; EMR; Referral/warm hand-off Older Adult Med/High (>25) Psycho-education; Motivational Interviewing; Collaboration with MD; EMR; Refer to UCI IMPACT alcohol AUDIT-C (3) Women- 3 Men- 4 (w/ 1+ pts from Q’s #6 or 7) AUDIT (10) TAY Med High Psycho-education; Motivational Interviewing; Collaboration with MD; EMR; Referral/warm hand-off Adult Med (8-19) High (>20) Psycho-education; Motivational Interviewing; Collaboration with MD; EMR; Referral/warm hand-off Older Adult Med (8-19) High (>20) Psycho-education; Motivational Interviewing; Collaboration with MD; EMR; Referral/warm hand-off other drugs Dr. Saitz’s 1-Q YES DAST (28) TAY Med/High (>12) Psycho-education; Motivational Interviewing; Collaboration with MD; EMR; Referral/warm hand-off Adult Med/High (>12) Psycho-education; Motivational Interviewing; Collaboration with MD; EMR; Referral/warm hand-off Adult Med/High (>12) Psycho-education; Motivational Interviewing; Collaboration with MD; EMR; Referral/warm hand-off intimate partner violence FWV 1-Q YES PVS (3) TAY Med/High (>1) Identify reporting requirements; Psycho-education; Motivational Interviewing; Collaboration with MD; EMR; Referral/warm hand-off Adult Med/High (>1) Identify reporting requirements; Psycho-education; Motivational Interviewing; Collaboration with MD; EMR; Referral/warm hand-off Older Adult Med/High (>1) Identify reporting requirements; Psycho-education; Motivational Interviewing; Collaboration with MD; EMR; Referral/warm hand-off
SBIRT%20Crosswalk_DRAFT_06-5-12.docx