New Hampshire Adolescent SBIRT: Screen and Intervene

JSI served as the backbone organization for the New Hampshire Adolescent SBIRT Initiative, which supported the implementation of universal screening for substance misuse behaviors among youth ages 12 to 22 by adopting Screening, Brief Intervention, and Referral to Treatment (SBIRT) protocols in 24 practice sites across 10 organizations throughout the state of New Hampshire.  The New Hampshire Charitable Foundation, in partnership with the Conrad N. Hilton Foundation, funded a three year substance use prevention initiative with primary care practices in New Hampshire. Implementing this proven prevention strategy assisted in identifying alcohol and drug use problems early when brief interventions are most effective, and fostered appropriate referrals to early and effective treatment for substance use disorders. The NH Center for Excellence provided technical assistance through an action learning collaborative and on-site support to facilitate the development of a community of practice for sites adopting this evidence-based approach.

The specific goal of this initiative was to facilitate adoption of SBIRT as a sustainable and universal practice in NH through:

1) the expansion of youth SBIRT in primary care settings, 
2) addressing policy and financial barriers as identified, and 
3) screening no less than 10,000 youth and young adults (ages 12-21) by 2017.

The project was structured as an action learning collaborative, engaging teams from the different clinical practice sites in shared learning and supporting sustainable system-based methods of quality improvement (QI). Facilitation of S·BI·RT implementation included:

• Training of office, medical, and nursing staff in the screening tools and Brief Intervention (BI) techniques;
• Technical assistance (TA) regarding improvements in work-flow and in the integration of the electronic medical record (EMR) with documentation of screening and data collection;
• Open resources on the S·BI·RT NH website www.SBIRTnh.org;
• A Playbook to guide clinical grantees in the implementation of S·BI·RT;
• Annual New Hampshire S·BI·RT Summits; and
• Communication strategies. 

We reached our goal to screen 10,000 youth by December 2016; by June 2017, the end of data collection, 15,126 youth had been screened across the 10 participating organizations, and 569 providers and other ancillary staff had received S·BI·RT training. Seventy-seven percent of youth seen in primary care for routine visits were screened using one of the suggested validated screening tools (CRAFFT, CRAFFT 2.0 or S2BI). Of those screened, 15% were found to be at risk for a substance use disorder (SUD). Of youth found to be at risk, 41% received a BI and 28% were at sufficient risk to need a referral to behavioral health (BH) services for further assessment and treatment. Most clinical sites made good progress at implementing screening into their office work-flow.