Factors that facilitate and impede adoption and implementation of screening, brief intervention, and referral to treatment in New York State school-based health centers

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 settings.  However, less than half of pediatricians even screen adolescents for substance use.

Methods:  Between May and June of 2013, an electronic survey was distributed to the total population of 162 New York State school-based health center (SBHC) program directors and clinicians who serve students of middle and/or high school age to identify factors which facilitate or impede adoption and implementation of SBIRT in this unique practice setting (40% response rate).

Results:  Less than 30% of survey participants felt they could be effective at helping students reduce their substance use, 63% did not believe it was their role to use a standardized screening tool, 20-30% did not feel confident in their ability to perform specific aspects of intervention and management, and 58% were unaware of SBIRT.  These factors were found to be associated with frequency of substance use screening and intervention practice (p<.05).  The greatest barriers to delivering SBIRT were time constraints, believing that students will be dishonest about their use, lack of training, not knowing where to refer students for treatment, and uncertainty regarding the effectiveness of available treatments. 

Conclusion:  Findings from this study suggest raising awareness of SBIRT and providing education and training which target role responsibility; self-efficacy; reducing barriers; and how, by delivering SBIRT, clinicians can effectively help students reduce their substance use.