Screening, brief intervention, and referral to treatment for adolescents: Attitudes, perceptions, and practice of New York school-based health center providers

ABSTRACT

Background: Screening, brief intervention, and referral to treatment (SBIRT) has been endorsed by the American Academy of Pediatrics as an evidence-based strategy to address risky substance use among adolescents in primary care. However, less than half of pediatricians even screen adolescents for substance use. The purpose of this study was to identify variation in SBIRT practice and explore how program directors' and clinicians' attitudes and perceptions of effectiveness, role responsibility, and self-efficacy impact SBIRT adoption, implementation, and practice in school-based health centers (SBHCs). Methods: All 162 New York State SBHC program directors and clinicians serving middle and high school students were surveyed between May and June of 2013 (40% response rate). Results: Only 22% of participants reported practicing the SBIRT model. Of the individual SBIRT model components, using a standardized tool to screen students for risky substance use, referring students with substance use problems to specialty treatment, and assessing students' readiness to change were practiced least frequently. Less than 30% of participants felt they could be effective at helping students reduce substance use, 63% did not believe it was their role to use a standardized screening tool, and 20–30% did not feel confident performing specific aspects of intervention and management. Each of these factors was correlated with SBIRT practice frequency (P < .05). Conclusions: Findings from this study identify an important gap between an evidence-based SBIRT model and its adoption into practice within SBHCs, indicating a need for dissemination strategies targeting role responsibility, self-efficacy, and clinicians' perceptions of SBIRT effectiveness.

Keywords:

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

Acknowledgments

The authors would like to acknowledge the work of John Yu, PhD, of the University at Albany 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 2014 Association for Medical Education and Research in Substance Abuse (AMERSA) conference and the 2014 American Public Health Association (APHA) annual meeting.

Author contributions

Brett R. Harris, DrPH, was responsible for research conception and design, data collection, analysis, interpretation of results, and writing the manuscript. Benjamin A. Shaw, PhD, provided guidance, oversight, and feedback in research conception and design, interpretation of results and participated in revision of the manuscript. Barry R. Sherman, PhD, and Hal A. Lawson, PhD, provided guidance in research conception and design and participated in revision of the manuscript.