Substance Use Prevention Investment Continues to Bear Fruit

Six years ago, the Conrad N. Hilton Foundation launched a major funding initiative led by then Program Officer Alexa Eggleston, designed to reshape the way the field approached adolescent substance use prevention. Initially the Foundation invested heavily in the development of new approaches to how we screen young people for early signs of difficulties associated with substance use in settings like schools and pediatric clinics. This first phase of the Foundation’s funding efforts resulted in the creation of a series of adaptations of an approach called SBIRT, or Screening, Brief Intervention and Referral to Treatment – a light-touch, population health approach to substance use prevention where a brief screening questionnaire is followed by an equally brief conversation with a young person focused on enhancing their motivation to seek treatment if needed.

Reclaiming Futures was among the first cohort of organizations to receive grants to innovate in this area, and we pushed the envelope creating a series of novel tools and brief intervention approaches, based on the SBIRT model, that were unique in content, context and in the technology we use. Our approach to SBIRT focused not only on substance use, but also mental health, and the strengths and assets a young person and their family bring to the table. Understanding the connection between public health, justice and equitable access to resources for both, we brought these new tools to juvenile justice and tribal settings, and community-based organizations that partner with youth serving systems. We also contributed to the creation of unique digital screening tools and remote, telehealth style strategies for engaging youth in SBIRT that have been both critical and very effective during the pandemic.

Though not completely unique in the field of philanthropy, what made the Hilton Foundation’s multi-year initiative stand out in many ways was the breadth and complexity of the funding strategy (more than 80 million dollars went to 56 grantees over the 6-years), and the recognition that to simply fund the development and evaluation of tools would not be sufficient. Eggleston and her team at the Hilton Foundation funded organizations at every layer of the adolescent health ecosystem, from school-based health centers, legal scholars studying the funding policies that drive public health, tech firms developing unique virtual training approaches, communication specialists, to public health policy advocates. Although the multi-year initiative, intended initially as a decade-long strategy, was cut short prematurely by an unexpected change in direction at the Foundation, much of the momentum around the work hasn’t slowed. In many ways the Foundation’s big bet was successful because Eggleston succeeded in launching a new field. Many of the organizations Hilton funded remain networked and continue to collaborate and innovate, creating and distributing valuable resources. 

Here at Reclaiming Futures, we’ve stayed on the cutting edge and continue to produce useful resources and strategies for the field - including a new SBIRT implementation playbook for school settings developed in partnership with Seattle Children's Research Institute, and a new model for how schools can integrate universal public health strategies like SBIRT into other school wide strategies involving restorative practices, community partnerships and multi-tiered systems of support. We also continue to expand and extend our work in juvenile justice systems, tribal settings, community-based organizations and in schools. For example, we have partnered with King County Washington to implement our SBIRT approach in 50 middle schools across 12 school districts and will soon begin implementing in an equal number of high schools there.

Another great example of this sustained momentum is the work of Alice Dembner and Avery Brien at Community Catalyst– a powerful national public health advocacy organization that has been both a strong voice for youth in the SBIRT conversation, but has also provided the field with some very useful resources over the years, including a newly updated SBIRT Toolkit designed to help schools navigate the funding landscape around adolescent treatment in the COVID era. Additionally, Abt Associates conducted an evaluation of the initiative and houses a number of great resources.

While no new major foundations have stepped into the breach to sustain and expand the work begun under the Conrad N. Hilton Foundation initiative, clearly important and innovative work continues.  If you have questions about the work of Reclaiming Futures and the resources we offer, contact Executive Director Evan Elkin at eelkin@pdx.org.