As we reflect on policies and practices for expanding and improving early identification and early intervention for youth, I would like to tie together what we just heard from the panel and with some of the Hilton Foundation’s work.

In 2012, the Hilton Foundation created the Youth Substance Use Prevention and Early Intervention Strategic Initiative and has funded 60 grants from across the nation to drive long-term systemic change to prevent substance use problems among youth. Ensure health providers have the knowledge and skills to provide screening and early intervention services Increase the number of providers by 25,000 through training, curriculum development, distribution of resource materials Improve funding for, access to and implementation of screening and early intervention services Increase the access to SBIRT to 30% of youth 15-22 Leverage $10 million for implementation and research Engage new settings in implementation: schools, community services, primary care Conduct research and advance learning to improve early intervention practices Increase knowledge regarding SBIRT effectiveness through research, collaboration of learning, dissemination of findings, assessing and publishing effectiveness of services in multiple venues

Monitoring, Evaluation, and Learning Project Measure progress toward meeting goals Identify key areas of learning and provide recommendations Collect data and use that data to advise the strategy Identify systems change needed to sustain implementation and support scalability of SBIRT The MEL was funded to support the implementation of the Strategy by:

Expanding SBIRT in Diverse Settings Offers Great Promise Now connecting the themes, both challenges and necessary practices for success, with the findings identified through the MEL project we have learned that: The panelist and grantees are implementing SBIRT in schools, community-based settings, and juvenile justice settings SBIRT implementation and challenges differ across types of settings There is great variability across sites in types of screening tools used and brief intervention models Allow for flexibility. Flexibility allows programs to fit SBIRT into their workflows and establish partnerships with local treatment and service providers

Utilize a Public Health Approach to Address Multiple, Complex Risk Factors Substance use is often one of many risk factors. The process of early identification for substance use is opening the door to conversations with youth about trauma, mental health, poverty, and violence. (grantees are integrating screening for substance use with screening for other risk behaviors or conditions) Systems-change and policy change that look at and connect these issues more broadly are likely to be more effective in preventing and stopping the progression of youth problems.

Establish a Solid Infrastructure Prior to Implementation Establishing a solid infrastructure is critical for successful implementation A great deal of planning is necessary to implement SBIRT, particularly in a new setting. Planning takes time and takes a team based approach Organization policies needed to support SBIRT– i.e. progressive not punitive policies (i.e. utilizing SBIRT services as an alternative to discipline in schools) Engagement of leadership and champions is key – building buy-in takes time but is essential Its important to understand the culture of the organization/settings and the youth served Data collection processes should be established prior to implementation ( for example, EHR protocols) – establish processes that will allow programs to use data for quality improvement

Create Partnerships to Support and Deliver Services Working with school administrators, health systems, public and private insurers, employers, treatment providers, recovery support providers, and other community supports and services This may include establishing partnerships with local advocates, media or communications experts, program evaluators Buy-in is critical. Relationships can make or break the success of the effort.

Invest in Tools, Technology and Training Workforce/advocates/policymakers must be educated and trained on an ongoing basis – must account for staff turnover and for the adoption of new practices Give people the tools (screening, training curriculum, data collection) and materials (for parents, school nurses) to make the implementation easier. Use technology whenever possible to communicate information (web, Mobile App) and to deliver interventions (text messaging)

Financing for Prevention and Early Intervention Services Remains a Challenge Prevention and Early intervention services aren’t sustainable without funding to support planning, training, and implementation Financing for SU prevention has historically been a problem – It is critical to explore new and existing financing mechanisms to sustain prevention and early intervention

Policies and Practices to Strengthen SU Prevention Utilize a public health approach Establish an infrastructure Create and maintain partnerships Invest in tools, technology and training Identify financing mechanisms Based on this, here are a few points I want to leave you with… Build the capacity of systems to better identify and address multiple risk factors by utilizing a public health approach Establish an infrastructure to scale up early identification and intervention across settings Encourage community level partnerships to strengthen programs Invest in resources to make systems change as easy for the stakeholders as possible. Identify financing mechanisms to sustain prevention and early intervention