Article by Tenille Metti, Former Assistant Communications Manager

On November 13, over 60 grantees, stakeholders, and members of our team gathered in Washington, DC for the Foundation’s second annual youth substance use prevention and early intervention strategic initiative convening.

On November 13, over 60 grantees, stakeholders, and members of our team gathered in Washington, DC for the Foundation’s second annual youth substance use prevention and early intervention strategic initiative convening. The program featured discussions about emerging efforts to reduce adolescent substance use; talks on how the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model may be adapted for youth; and featured highlights from several grantees’ first year of program activity.

During the discussions, a consensus emerged between researchers and implementers that “it’s not a matter of if we do SBIRT, but how.” The attendees emphasized that “one size does not fit all” when it comes to addressing adolescent substance use, and interventions like SBIRT will need to take into account different individuals and settings. Flexibility is crucial when addressing a complex issue like adolescent substance use.

At the Foundation, we recognize the need for flexibility, in order to respond to the experience of agencies and practitioners in the field who are carrying out the work. Our approach is designed to help us evaluate and respond to the knowledge gleaned from their experience and identify key learning to inform the future of each strategic initiative. The annual convening provides a critical opportunity to bring together stakeholders, policymakers, other funders and grantees to share best practices and emerging trends in the field. The Foundation is not looking for the “one size fits all” solution; rather, we are interested in developing realistic and tailored solutions that respond to the needs of youth and young adults.

Substance Use Prevention convening 2

We asked three panelists who took part in the convening to share their thoughts:

Tym Rourke, Director, Substance Use Disorders Grantmaking and Strategic Initiatives at the New Hampshire Charitable Foundation

“Good clinical practice includes meeting the patient or client “where they are at.” When it comes to SBIRT, the same can be said about health centers themselves. There is incredible variety in our healthcare system – from everything to different Electronic Medical Records to divergent methods of workflow, staff accountability and patient/staff interface. Truly effective implementation takes into account this diversity, to ensure that protocols are developed with the culture of the individual healthcare center in mind. Then, the sustainability across the diverse systems is enforced with a policy and financing environment that empowers health centers to continue and expand the new practice. We see these threads being woven together in our work in New Hampshire. While our grantee sites are approaching implementation differently, they do so towards the common purpose of bringing universal screening for substance use to youth and young adults.“

Dr. Olga Acosta Price, Associate Professor, Department of Prevention & Community Health
The George Washington University

“The promise of SBIRT as an effective early intervention approach for youth has fueled an increase in empirical studies and examinations of best practices in implementation. There is likely no more promising collaboration that has the potential to yield greater impact for adolescents than the integration of SBIRT into the school setting, but only if the influence of culture and context are recognized. Education and health systems can be said to operate within two distinct cultures, both with different funding, political drivers, and priorities. Although stakeholders within both systems work to support the development of successful, healthy, and productive citizens, their dissimilarity often makes partnering to achieve this common goal feel like an unnatural act. Furthermore, the conditions in and around schools can make or break any intervention or approach, no matter how well developed or researched. The number of demands already placed on school personnel, the policies that determine actions taken when adolescents are caught using substances, the value placed on parental involvement and supervision, the availability (or not) of qualified community providers—these contextual factors are as likely to determine the success of any school-connected substance abuse prevention intervention as does the efficacy of the SBIRT approach itself. Only solutions that consider the complexity of culture and context, for the individual as well as the systems they operate within, will ultimately fulfill their promise.”

Dr. Sharon Levy, Director, Adolescent Substance Abuse Program, Children’s Hospital Boston
Assistant Professor of Pediatrics, Harvard Medical School

“Spurred by the imperative to reduce the enormous and preventable morbidity and mortality caused by adolescent substance use, a policy level mandate already exists to deliver SBIRT to adolescents as part of routine health care. Brief interventions to address substance use in medical settings are an exciting approach because of their low cost and few, if any, risks. However, the U.S. Preventive Services Task Force has found the literature to date insufficient to evaluate the effectiveness of brief interventions for substance use among adolescents in primary care, begging the question of which adolescents benefit from which interventions. As with any behavioral intervention, studying SBIRT in real world settings is vexingly complex—feasibility, acceptability, fidelity, efficacy and generalizability all need to be measured in terms of real-life, patient-centered outcomes such as educational attainment that can take years to track. A strategy that includes processing data from service-based projects is a pragmatic solution—adolescents get “best practice” SBIRT as defined by expert clinicians as the field learns what works.“

The Foundation embraces the need for innovative and collaborative approaches in its grantmaking to prevent and reduce substance use among youth. We look to our partners, our evaluation, and researchers and implementers in the field to learn how to appropriately adapt SBIRT for each adolescent. Together, we are confident that we can effectively address youth substance use disorders.