Screening and brief intervention in high schools: School nurses' practices and attitudes in Massachusetts

ABSTRACT

Background: Screening, brief intervention, and referral to treatment (SBIRT) is recommended as a strategy to prevent or reduce adolescent substance use. Offering SBIRT in schools may provide an opportunity to reach adolescents not accessing primary care. The objective is to assess school nurses' attitudes and practices regarding adolescent SBIRT. Methods: The authors administered electronically and in person a questionnaire including 29 items on SBIRT attitudes and practices to school nurses registered for the Northeastern University's School Health Institute Summer Program in Massachusetts (N = 168). Survey questions were adapted from a questionnaire originally developed by the American Academy of Pediatrics. Results: One hundred and forty-four nurses completed the survey for a response rate of 85.7%. More than three quarters of the respondents (77.0%) were in favor of universal alcohol screening in schools. None of the respondents reported screening their students on a regular basis. More than half (64.4%) of nurses reported screening students; however, they did so only when they suspected alcohol use. During these instances, only 17.9% used a validated screening tool and almost all (98.2%) used face-to-face clinical interviews. When addressing alcohol use by a student, the large majority of respondents reported including the following recommended clinical strategies: asking about problems related to alcohol use (56.3%), explaining the harms of alcohol use (70.1%), and advising abstinence (73.6%). On average, respondents spend 5 to 10 minutes discussing alcohol use with their students. Conclusion: Survey respondents were supportive of universal alcohol screening in school, although few were doing so at the time. When respondents identified students using alcohol, their interventions were closely aligned with clinical recommendations for brief intervention. Implementation of SBIRT that focuses on standardized, annual screening has the potential to deliver high-quality care in this setting.

KEYWORDS:

• Alcohol
• brief intervention
• school health
• school nurses
• screening
• substance use

Acknowledgments

We would like to acknowledge Mary Ann Gapinski at the Massachusetts Department of Public Health for helping prepare the survey instrument and for providing feedback on this manuscript. We would also like to acknowledge, Kathy Hassey, from Northeastern University, for assisting with survey administration and support. The authors declare they have no conflicts of interest.

Funding

This study was supported by grant 5U79-TI025389 from the Substance Abuse and Mental Health Services Administration. The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. This study was also funded by Conrad N. Hilton Foundation (CNHF20140273) and the National Institute on Alcohol Abuse and Alcoholism (R01AA021913).

Author contributions

J.L., E.R.W., and S.L. designed and conducted the study. D.K. managed data collection. All authors contributed in the analysis and interpretation of the data. All authors drafted, revised, and approved the final manuscript.