T-SBIRT Protocol Addresses Trauma Exposure

T-SBIRT Protocol Addresses Trauma Exposure

By Dimitri Topitzes

Trauma screening, brief intervention, and referral to treatment, or T-SBIRT, is a brief, standardized, semi-structured protocol developed at the Institute for Child and Family Well-Being for use within health and social service settings. Adapted from the original SBIRT for substance misuse,1 T-SBIRT addresses trauma exposure and symptoms among recipients of health and social services. Research has shown that psychological trauma can have lasting negative effects on physical, psychological and social well-being.2 Even more, trauma can undermine peoples’ ability to engage in and respond well to professional services such as primary healthcare and employment services.3,4 With this in mind, the Institute designed the protocol to help remove barriers to: a) effective service engagement and b) personal well-being.

T-SBIRT consists of the following elements: (1) seeking permission to address stress and trauma; (2) assessing for stress and trauma exposure; (3) screening for post-traumatic stress symptoms; (4) asking open-ended questions about positive and negative coping strategies; and (5) prompting and reinforcing statements reflecting motivation to improve coping strategies such as help-seeking behaviors. Requiring anywhere from 10 to 30 minutes to complete within health or social service settings, the protocol culminates in a referral to mental health treatment or other supports when indicated along with instrumental and motivational strategies to facilitate referral completion. T-SBIRT providers offer referrals when participants endorse trauma exposure along with any related effects such as formal PTSD symptoms or negative coping strategies. Referral procedures follow best practices, i.e., appointments are made during T-SBIRT sessions, and common referral destinations include trauma counselors, primary care physicians, and housing support specialists.

Evident in the structure of T-SBIRT are hallmark trauma-informed principles and practices such as client empowerment and choice, provider-client collaboration, and screening and referral processes.5,6 In fact, T-SBIRT providers work closely with referral partners that offer well-validated services, including trauma-specific mental health treatments that reduce PTSD symptoms. As such, T-SBIRT relies on interagency collaboration and evidence-based practices, both important components of trauma-responsive practice.7

The T-SBIRT model has been implemented in multiple service contexts. Results from a study assessing the feasibility of implementing T-SBIRT within community-based primary care clinics suggested that the protocol was acceptable to the patient sample (N=112). Moreover, it addressed a common problem among the patients, as 92% experienced significant trauma in their lives and 55% screened positive for post-traumatic stress disorder. Finally, 63% of the sample accepted a referral to a behavioral or mental health treatment provider as a result of participating in the T-SBIRT protocol.8 When integrated within alternative healthcare and social service settings, such as a nurse home visiting program and an employment service program, T-SBIRT produced similar feasibility results.9 For more information, see the T-SBIRT Issue Brief.

Learn More:

ICFW T-SBIRT Issue Brief
Journal Article: Complementing SBIRT for Alcohol Misuse with SBIRT for Trauma: A Feasibility Study
Journal Article: Implementing Trauma Screening, Brief Intervention, and Referral to Treatment (T‐SBIRT) within Employment Services: A Feasibility Trial


1.Babor, T. F., McRee, B. G., Kassebaum, P. A., Grimaldi, P. L., Ahmed, K., & Bray, J. (2007). Screening, Brief Intervention, and Referral to Treatment (SBIRT) toward a public health approach to the management of substance abuse. Substance Abuse, 28(3), 7-30.
2.Mersky, J. P., Topitzes, J., & Reynolds, A. J. (2013). Impacts of adverse childhood experiences on health, mental health, and substance use in early adulthood: A cohort study of an urban, minority sample in the US. Child Abuse & Neglect, 37(11), 917-925.
3.Chartier, M. J., Walker, J. R., & Naimark, B. (2010). Separate and cumulative effects of adverse childhood experiences in predicting adult health and health care utilization. Child Abuse & Neglect, 34(6), 454-464.
4.Topitzes, J., Pate, D. J., Berman, N. D., & Medina-Kirchner, C. (2016). Adverse childhood experiences, health, and employment: A study of men seeking job services. Child Abuse & Neglect, 61, 23-34.
5.Substance Abuse and Mental Health Services Administration (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. HHS Publication No. (SMA) 14-4884. Rockville,MD: Author.
6.Berliner, L., & Kolko, D. J. (2016). Trauma informed care: A commentary and critique. Child Maltreatment, 21(2), 168-172.
7.Lang, J. M., Campbell, K., Shanley, P., Crusto, C. A., & Connell, C. M. (2016). Building capacity for trauma-informed care in the child welfare system: Initial results of a statewide implementation. Child Maltreatment, 21(2), 113-124.
8.Topitzes, J., Berger, L., Otto-Salaj, L., Mersky, J. P., Weeks, F., & Ford, J. D. (2017). Complementing SBIRT for alcohol misuse with SBIRT for trauma: A feasibility study. Journal of Social Work Practice in the Addictions, 17(1-2), 188-215.
9.Topitzes, J., Mersky, J. P., Mueller, D. J., Bacalso, E., & Williams, C. (in press). Implementing Trauma Screening, Brief Intervention, and Referral to Treatment (T‐SBIRT) within Employment Services: A Feasibility Trial. American Journal of Community Psychology.
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