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An Effort to Stop Student Drug Use That Starts With a Simple Conversation at School

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An intervention that was originally designed for adults in clinical treatment settings is being pitched as a school-based solution to the opioid crisis.

To determine which students are using drugs or at risk of using drugs, schools should ask them directly in confidential interviews. That's the pitch made by the President's Commission on Combating Drug Addiction and the Opioid Crisis, which released its final recommendations this week.

The screening method is called SBIRT, which stands for Screening, Brief Intervention, and Referral to Treatment. Included in the task force's list of 56 recommendations for addressing the opioid crisis is a call for the U.S. Department of Education to promote SBIRT and similar screening programs for use in middle and high schools.

"The screenings do not involve drug tests, but rather a screener (school nurse or psychologist trained in conversations on drug use with youth) to determine through a conversation/questionnaire if the student is engaged in risky substance use," a report by the task force says. "The intent is to identify students who need help and to try to motivate them into treatment. Students or parents can opt out of the screening and parents are not immediately notified of the screening results to protect students' privacy. Parents are notified only in severe cases of addiction."

How Does SBIRT work?

The task force calls for having trained school employees administer the screening program privately and universally, exempting only the students whose parents opt them out. There are a variety of brief questionnaires that can be used to measure a student's risk for drug use. One of the most commonly used is called the CRAFFT screen, which asks students if, in the past 12 months, they have had more than a few sips of alcohol or used drugs to get high.

The screening also includes some questions to determine risk for students who are not using, including, "Have you ever ridden in a CAR driven by someone (including yourself) who was 'high' or had been using alcohol or drugs?"

Interviewers affirm positive choices for students who don't show risk for drug use. Students who score in a medium range are given a "brief intervention" during which the interviewer talks to them about the effects of their behavior and how to make healthy choices. Students whose answers show them to be most at risk may be referred to treatment after a phone conversation with their parents.

A Massachusetts law that took effect in 2016 requires schools to adopt annual SBIRT screening for at least two grade levels and provides training and resources for school staff. This introductory video from a state SBIRT website shows a demonstration of a school-based screening. You can also see the state's other training resources here.

Will Students Really Be Honest About Their Drug Use?

Studies of SBIRT in school-based settings have found some promising results.

Some students may be hesitant to discuss their risky behaviors with adults at school, but some are open to sharing once they are given a safe space to do so, leaders of the School-Based Health Alliance said. 

The organization has piloted the use of the SBIRT screening in school-based health centers, which are on-site health clinics that treat a variety of primary care, mental health, and behavioral issues in schools.Those clinics bill for their services through Medicaid and traditional health insurance programs, and they sometimes receive private grant funding to help cover operating expenses.

The advantage to screening in a health center—as opposed to asking general school staff to administer the interviews—is that health care providers have established relationships of patient confidentiality with students, who may already see them for issues ranging from sore throats to mental health concerns, said Seleena Moore, a program manager for the School-Based Health Alliance.

The organization's pilot, funded by the Conrad N. Hilton Foundation, provided training in interviewing for school health center employees. Pilot sites also provide support, including individual and group counseling, for students who are identified as at-risk through the screening tool. The second phase of the pilot has involved efforts to "change the culture" around drug use in schools and to solicit more feedback from students about how to make the program effective.

Schools administering screenings like SBIRT outside of the confidential settings of health centers may have to address some concerns, like confidentiality, said John Schlitt, the CEO of the School-Based Health Alliance. That's especially true in schools with zero-tolerance policies against drug use.

"If [students] know they are admitting to something that could get them in trouble with the school, the school has to kind of reconcile that," he said. "Why would students admit to something that's going to get them suspended?"

Schlitt and Moore said they will need to gather more information to determine if the screening is an effective way to counter the opioid epidemic. But, in the meantime, the interviews could be a safe place for students to admit their parents or family members are using or to address larger concerns, they said.


Further reading on opioids and schools:

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