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North Hampton Schools
SBIRT Pilot Program
What did results show?
Positive screen referrals:
-school adjustment counselor follow up
-additional counseling with social worker
-if necessary, contact parents and refer to outside treatment
Score of 0= positive encouragement and information of risks given
Score of 1= brief advice on health risks and encouraged to stop use (at that time or at follow up visit with nurse)
Score of 2+= positive screen
Goal: address and reduce youth that present with risk factors through screening
- Parents informed, given the option to opt out (7did)
- Conducted for all freshmen during routine screenings (BMI and vision/hearing) by school nurse
- Students informed of purpose and confidentiality, given option to opt out (1 did)
- All data recorded on paper with no identifying information
- Student filled out screening tool while nurse set up other screenings and nurses reviewed and discussed answers with student
North Hampton Results:
-Positive Screens matched known use data
-25/221 required brief interventions
-5 of those 25 were positive screens of 2+ that required referrals
How can SBIRT be used?
Adults
Adolescents
SBIRT
- Various studies currently being conducted
- Early prevention for all students
- Assessment and treatment for known users
Screening, Brief Intervention, Referral to Treatment
- Incorporated into routine practice: primary care, specialists, other clinicians
- Used to assess risk, reinforce positive behaviors, or connect to behavioral health specialist
- Required under the ACA for Patient Centered Medical Homes
What is SBIRT?
An evidence-based approach used to identify early substance abuse risk factors, reinforce positive behaviors or educate on reducing or limiting use
Goals
Objectives:
- Understand what SBIRT is, why it is used, and how to use in schools
- Know how to use an evidence based tool to identify substance use
- Understand the components of a Brief Intervention and Motivational Interviewing
- Know when to make an appropriate referral to treatment
- Identify those who are at-risk with basic screening questions
- Identify substance abuse needs and direct to appropriate care
- Strengthen trusting relationships with students
- Provide accurate information on risks
Adolescent Screening Tools
Referral to Treatment
With a 'positive screen', negotiate a referral to a behavioral health specialist
CRAFFT
- Adolescents (9-18)
- Alcohol and Drugs
- 6 Questions
Possible Referrals:
1. School social worker or substance abuse counselor
2. Behavioral Health Professional outside school
REMEMBER!
You are a student's advocate that what they're dealing with is a medical problem and NOT a disciplinary problem.
JASAE
- Adolescents
- Alcohol, Other Drugs, as well as issues and attitudes
- 107 questions
Screening
Questions
What's the need?
Identifies substance use and risky behavior patterns and history
Among Cumberland County High School Students; 2013 MIYHS data
- Can be incorporated into routine practice
- Short series of questions; gathers information to refer for an assessment
- Evaluates level of risk; is not diagnostic
1. How would this program work in your school? What steps would have to be taken to implement this?
2. What barriers to you anticipate if you were to implement SBIRT?
Substance abuse and addiction as medical problems
13% reported, in the past 30 days, riding in a vehicle with someone who had been drinking alcohol. (20% for marijuana)
30% who reported smoking cigarettes started smoking before age 13 (22% for alcohol, 18% for marijuana)
1 in 4 reported drinking alcohol in the past 30 days
Half of students believe there is no risk in regular marijuana smoking
12% reported taking a rx drug that was not prescribed to them
Teens and Addiction
- Biological mechanism established
- Recognizable signs and symptoms
- Identifiable risk factors
- Predictable outcomes
- Responds to treatment
- Brain is not fully developed
- Alcohol severely affects the hippocampus (learning and memory) and pre-frontal cortex (decision making/executive functioning); two main regions still in development
- Brain is at peak plasticity; making learned information and behavior more hard wired. This means that addiction pathways are more easily learned and harder to break than an adults.
Thank You!
Jana Thompson
jana.thompson@opportunityalliance.org
Heather Drake, MPH
heather.drake@opportunityalliance.org
Does it work?
How much is too much?
In North Hampton:
-Nurses found the screening to be valuable in relationship building
-86% students reported they were 'mostly' or 'completely' honest with nurse
-27% reported they were 'less likely to use alcohol or drugs' after screening
-Effectiveness of SBIRT with youth is being studied across the country in many pilot projects.
-Studies can be difficult because parents have to agree.
Motivational Interviewing
Brief Intervention
Four General Principles
Because of brain development, risky behavior for adolescents really means any use or associated behaviors.
For adults, we assess risk differently (number and frequency of alcoholic beverages, loss of interest in activity or family, etc.).
Short in length, reinforces positive behavior or helps reduce problematic behavior, follows discussion of screening score
Other studies:
-Use of screen in pediatric hospitals, school based health centers, juvenile correctional facilities, public schools, primary care pediatricians
-Better results when parents are involved in process, especially brief intervention
-Studies have shown early results of decrease in risky behaviors such as driving while intoxicated and decrease in drug use, as well increase in prevention of those that had not yet used
- Express Empathy
- Develop Discrepancy
- Roll with Resistance
- Support Self-Efficacy
Start prevention EARLY- the largest jump in use is between 8th and 9th grade so prevention needs to start BEFORE high school or use is suspected.
- Develop rapport
- Provide feedback on screening
- Listen to patient's opinion
- Discuss options and make a plan