A Multi-Site Case Study Evaluation of Mandated SBIRT Policy in Massachusetts Public Schools

Introduction. A 2015 Massachusetts bill requires that all schools offer Screening Brief Intervention and Referral to Treatment (SBIRT) to middle and high school students to advance universal and indicated prevention of alcohol and other drug use and to help address access barriers for youth needing/seeking healthcare. Understanding acceptability of school SBIRT and markers of success is vital for state-scaled implementation and outcomes evaluation.

Methods. A mixed-methods evaluation using data collected and analyzed from staff focus groups (FGs) and student surveys to ascertain factors associated with acceptability in 2 districts with 5 schools & 1,326 youth. FGs (n=4) with n=46 nurses and guidance counselors, were facilitated by research staff, audio recorded and analyzed thematically. Youth in grades 7, 9, & 10 who participated in SBIRT in 2016-17 were anonymously surveyed (under passive parental consent); data were analyzed using descriptive statistics. FG and survey data were triangulated to understand staff and student perspectives together.

Results. In FGs, strong leadership, logistical support, interprofessional focus on education and relationship-building with students were associated with successful implementation. Challenges included perceptions of low parental support and student disclosure, concern for privacy, and staff burden. Among 805 student survey participants (participation 78.3%): 9.6% and 36.8% of middle and high schoolers reported past year alcohol use, with 42% and 59% of users reporting a past year binge, respectively (p<0.0001). Overall, 67% agreed/strongly agreed that staff should screen students; a minority agreed/strongly agreed that “screening is an invasion of privacy” (37.9%) and “a waste of time” (30.8%). Receptiveness towards screening was higher among those who did not report past year substance use (p <0.0001). Among students who reported being screened (n=432), 97.2% reported answering all/some questions honestly, and most agreed/strongly agreed that they felt comfortable (71.3%), their privacy was respected (84.5%), the information was useful (73.6%). Two-thirds (62.3%) agreed/strongly agreed they would return to the staff member who screened them for questions about AODs, with more agreement among past year substance users (p <.034).

Conclusion. For staff, program acceptability was high despite challenges, with success reframed as relationship building not youth disclosure. Students reported high acceptability and candid disclosure; their stated openness to returning to staff to discuss AOD use was a key indicator of success and bodes well for case finding and clinical response to at-risk youth. Results are promising for a strategy that extends SBIRT to schools and are an important early indicator of feasibility and impact as the policy rolls out to a state scale.