Communicating about screening, brief intervention, and referral to treatment: Messaging strategies to raise awareness and promote voluntary adoption and implementation among New York school-based health center providers

ABSTRACT

Background: School-based health centers (SBHCs) are satellite primary care clinics conveniently located within high-risk schools. Providing screening, brief intervention, and referral to treatment (SBIRT) in SBHCs has the potential to greatly increase identification and intervention among adolescents with problem substance use. Nevertheless, only 11% of New York State SBHC providers report the use of SBIRT. This study identifies strategies for communicating about SBIRT with the goal of raising awareness and promoting voluntary adoption and implementation among both SBHC program directors and clinicians. Methods: All 162 New York State SBHC program directors and clinicians serving middle and high school students were surveyed between May and June 2013 (40% response rate). Program directors were asked which factors were most important to them in their decision to adopt new practices, and both program directors and clinicians were asked to rank-order statements in 2 categories: (1) Substance use and its effects and (2) SBIRT integration and outcomes. Results: Student need was valued far more than any other factor in program directors’ decisions to adopt new practices. Both program directors and clinicians perceived the association between substance use and risky sexual behavior and the benefits and cost-effectiveness of SBIRT compared with other preventive health screenings as the strongest motivators to adopt and implement SBIRT. Conclusions: Findings from this study suggest that SBIRT awareness-raising strategies present the cost-effectiveness of SBIRT, highlight student need, particularly the connection between substance use and risky sexual behaviors, and should be communicated by state health departments and professional organizations.

KEYWORDS:

• Adolescents
• communication
• implementation
• practice dissemination
• SBIRT
• school-based health centers
• screening, brief intervention, and referral to treatment
• substance abuse

Acknowledgments

The author would like to acknowledge the work of Benjamin Shaw, PhD, and Barry Sherman, PhD, of the University at Albany School of Public Health and Hal Lawson, PhD, of the University at Albany School of Social Welfare for providing guidance and feedback in research conception, design, and interpretation of results; John Yu, PhD, of the University at Albany School of Social Welfare for feedback on the survey; Thomas Tallon of the New York State Department of Health for facilitation of survey distribution; and Tosan Oruwariye, MD, and Alida Quinones-Reyes of Morris Heights Health Center for pilot testing the survey. This work was presented at the 2015 Association for Medical Education and Research in Substance Abuse (AMERSA) conference and the 2015 American Public Health Association (APHA) annual meeting. There were no sources of funding to carry out this work. The author declares no conflicts of interest.

Author contributions

Brett R. Harris, DrPH, was responsible for research conception and design, data collection, analysis, interpretation of results, and writing the manuscript.