8 SBIRT Perceived Barriers

Attachment 13: PERCIEVED BARRIERS TO SBIRT QUESTIONAIRE

Web-based Skills Training for SBIRT (Screening Brief Intervention and Referral to Treatment)

OMB # 0925-XXX

Expiration Date xx/xxxx

Public reporting burden for this collection of information is estimated to average less than 3 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Each time the assessment is completed, it is expected to be completed in a single sitting. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-xxxx*).  Do not return the completed form to this address.

Perceived Barriers to SBIRT Questionnaire – Administered at Baseline and Follow-up

1. In your medical practice, how much do each of the following barriers interfere with your ability to deliver alcohol, tobacco, and substance abuse interventions?

	Not at all (0)	(1)	(2)	(3)	Extremely (4)
Lack of time
Lack of availability of health educators
Insufficient/lack of reimbursement
Lack of systems for tracking and prompting these interventions
Lack of patient interest
Uncertainty of what interventions to provide
Lack of proper patient educational materials
Communication difficulties with patients
Cultural differences between doctors and patients
The patient came for a different purpose