Reclaiming Futures SBIRT Implementation: Progress & Plans

Before sharing our accomplishments and expansion efforts, let’s take a moment to acknowledge numerous people and organizations that we have had the privilege of working with over the past few years to implement Reclaiming Futures’ version of Screening, Brief Intervention, and Referral to Treatment (RF-SBIRT).

First, we must acknowledge the youth and families who have agreed to participate and engage in a process of considering how substance use and mental health concerns might be affecting their goals. This may not have been easy and we appreciate their willingness.

Second, the SBIRT coordinators, project directors and other project staff have collaborated to provide us with critical feedback, offered in the kindest way, on aspects that needed improvement. Project staff also shared examples of how RF-SBIRT is empowering young people and their families to decide to work towards their goals keeping health and wellness in mind. Repeatedly, we hear the strength-based screening helps engage youth and families. The screening combines a series of strength-based questions and the Global Appraisal of Individual Needs Short Screener. It screens for a young person’s self-identified strengths and symptoms related to mental health and substance use. The information is used to start a conversation with a young person to affirm their strengths and determine if they would benefit from the brief intervention and/or referral to other services and supports.

Third, the Conrad N. Hilton Foundation (Foundation) has provided leadership, expertise, resources, and support to expand the use of SBIRT with adolescent populations across the country. The Foundation’s goals for SBIRT are:

1. Ensure health care and other youth providers have the knowledge and skills for screening and early intervention services
2. Improve funding for, access to, and implementation of screening and early intervention services
3. Conduct research and advance learning to improve screening and early intervention practices

The Foundation has funded projects in a variety of areas including local and state-level advocacy and education, implementation of SBIRT in school-based health and wellness centers, medical and juvenile justice settings, employee training programs, and so much more. It is impressive to see the goals operationalized in such diverse yet related ways.

Fourth, we acknowledge Abt Associates and its partnering organizations for leading the evaluation, training and technical assistance efforts for the Foundation’s SBIRT funded sites, and Impact Justice for evaluating our own implementation. Understanding strengths and areas for improvement ensures we are offering quality services and supports to youth and families.

Fifth, four sites representing six counties in Ohio have invested in RF-SBIRT, participated in training, begun implementation, and contributed to its refinement. We appreciate their commitment to youth and families in Ohio.

These acknowledgements are relevant for numerous reasons, but in particular, because in 2016 the former United States Surgeon General released a report on alcohol, drugs, and health. The report indicated that alcohol and drug misuse is a critical public health concern, and it affects millions of youth and families across the country. It was a call to action for prevention, treatment, recovery, and health care to work together to address and respond to the public health crisis of substance misuse and related disorders. It is important to involve health care systems and other systems such as schools, juvenile justice, and child welfare. Young people and families who are affected by alcohol and drug use may present in a variety of settings. As such, we must be able to respond effectively regardless of where they may present.

 Our Accomplishments

Since our last update, we are pleased to share our cumulative accomplishments in the areas of youth and family involvement, training and technical assistance, and evaluation that are aligned with the Foundation’s goals. Table 1 displays the number of project activities completed between February 2015 and March 2017 followed by a brief discussion of additional accomplishments.

Youth and Family Involvement

• We have engaged 242 youth and families in RF-SBIRT. While we are still working to meet our goal of 500 youth included in the evaluation, we have gathered plenty of implementation data, which will contribute to our learning about RF-SBIRT.
• We aim to ensure our materials and approaches respond to the needs of culturally diverse groups. For example, we use images and case studies that reflect diverse racial, ethnic, gender, physical and learning abilities, and sexual orientations. We have Spanish versions of all the evaluation, screening, and brief intervention materials. We use gender-neutral language in our trainings and materials. We improve access for those with visual impairments by using recommended font types, color contrasts, and alternative text on images, graphics, and tables. These are substantial and modest ways we demonstrate our commitment for creating an inclusive RF-SBIRT environment. Yet, we know that cultural responsivity means consistently demonstrating respectful and authentic interactions with youth and families, project staff, collaborators, and funders, and always keeping in mind the wide-ranging worldviews.

Training and Technical Assistance

• The 2017 RF-SBIRT training plan has been implemented and we continue to expand and diversify our training modalities (e.g., online short webinars; training video development)
• Related to training and technical assistance, two project staff offered these reflections about implementation

• The training from local expertise has helped to enhance my Motivational Interviewing techniques, specifically focusing on utilizing the skills of reflective discussion and open-ended questions to facilitate an open dialogue with clients and parents. This training has helped me to work with clients in identifying how their current usage/behavior could impact their future goals and what steps they can take to achieve their goals moving forward.  - Katie Marshall, Chittenden County Court Diversion

• We found, with implementation of the model, a willingness to be flexible went a long way. When we first began the implementation process and laid everything out on paper, it looked great. After we started doing the work, we realized some changes needed to be made in where we had situated the intervention. An openness to flexibility with our implementation plan while maintaining the fidelity of the model was one way we found success in providing this intervention at our site.” - Katherine Wiley, Washington County SBIRT Coordinator

Evaluation

• We have a Portland State University; Institutional Review Board approved research protocol. Additionally, we have a National Institutes of Health Certificate of Confidentiality to add extra protections for youth participants and their data.
• We continue to collect data at intake (screening) and 3- and 6-months post intake. We continue to work on improving the quantity and quality of data collection efforts.
• We are collecting data on demographics (e.g., race/ethnicity; age; sexual identity and orientation), substance use and mental health symptoms, age of first use and frequency of alcohol and marijuana use, school difficulties, legal involvement, placements (e.g., group homes; foster care), beliefs about alcohol and drug use, and perception of and satisfaction with the SBIRT process. These data will help us answer these four evaluation questions:
  • Does RF-SBIRT allow program staff to provide accurate mental health and substance use referrals?
  • Does RF-SBIRT lead to positive behavior health, youth development, and juvenile justice outcomes for youth?
  • Does RF-SBIRT shift program staff views of behavior health problems among youth?
  • Is SBIRT an effective screening, intervention and triage tool for youth in juvenile justice diversion meetings?

Expanding RF-SBIRT

King County, Washington

RF-SBIRT is expanding in King County, Washington. Under the Best Starts for Kids initiative, King County has established a license agreement with Portland State University, Reclaiming Futures to implement RF-SBIRT in more than 100 middle schools. The aim is to identify and intervene with young people who may have substance use and mental health concerns. As indicated, we will use our manualized brief intervention to work with young people and their caregivers and, if necessary, provide referrals for assessment, services, or supports.

It is important to recognize that the evidence that supports SBIRTs efficacy and effectiveness for adolescents is limited. Yet, we have designed RF-SBIRT based on the most rigorous evidence available, which shows the importance of multiple sessions that are longer in duration as compared to typical brief interventions, and includes caregivers. We also anticipate that RF-SBIRT will offer schools a greater understanding of substance use and the related issues and provide alternatives for disciplinary actions to keep young people in school, families involved, and additional services and supports.

King County has taken a strategic approach for expanding RF-SBIRT by first engaging with schools to seek their interest and then requesting information. Subsequently, schools will be engaged in planning and implementation workshops resulting in actual implementation. As we have learned, implementing RF-SBIRT in settings such as schools and juvenile justice requires deliberate planning and coordination to work through many of the initial issues that arise with implementation. Questions that arise vary from policy and practice to logistical issues. For example, questions such as: Do we screen all youth or a sub-set of youth?  How do we know if they would benefit from a brief intervention? How do we engage families?  What room/office do we use to conduct the brief intervention? How do we comply with privacy and confidentiality laws? How do we make a referral and to what organizations? These types of questions are important to work through, prior to implementation, and we look forward to collaborating with King County and the participating schools.

Collaborating with Tribal Communities

Through a partnership with the Center for Court Innovation, we are working to develop and expand a tribal version of RF-SBIRT. We started by working with the Yurok Tribe and have the opportunity to work with several more tribes.

We are proud of our accomplishments, energized for continual improvement, curious to see the evaluation results, and encouraged by the expansion process. Stay tuned for more RF-SBIRT news.