Implementing Adolescent SBIRT

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based approach to early intervention of substance use.

This mixed-methods evaluation assessed the implementation of an adolescent SBIRT change package across 13 primary care clinics in the United States. These clinics participated in an 18-month learning collaborative, during which they received training and technical assistance on SBIRT practices. 

Six major themes emerged around the implementation of the change package:

1) operational readiness of the sites- results indicated the importance of having cohesion and dedication amongst the team members.

2) training of staff members- The need to train staff on SBIRT practices emerged as a theme through the site visits. This was directly related to success of program implementation. There was significant variation across sites in which staff were offered training. Furthermore, results indicated a need for guidance in fitting SBIRT activities into their existing clinical practice.

3) the screening process- there were several barriers highlighted as part of the screening process. These included knowing what what screening to conduct and the most effective way of administering screening. The 3 most common barriers were insufficient time, lack of trust in the patient, and lack of privacy to administer the screen.

4) intervention delivery- When assessing for the belief that brief interventions were effective, only marginal differences existed among staff positions. As with screening, the 3 most common barriers were insufficient time, lack of trust in the patient, and lack of privacy to administer the intervention.

5) the referral process- Site visit summaries showed that sites varied in terms of their capacity to make referrals. Referral capacities and sources remained stable over time. The biggest difference revealed through this evaluation was the ability to track the referral. 

6) the adaptation and utilisation of the electronic health record (EHR)-  Across sites, records were either stored directly in the EHR, existed as scanned files, paper files, or some combination of the three.

Conclusions: Through the guidance of the change package and the associated training and technical assistance, the participating primary care clinics were able to implement SBIRT practices within their existing workflows. There was also an observed reduction in reported substance use among the at-risk adolescents served by these clinics.