1. MA Statewide SBIRT Initiative SBIRT in Schools
Early Identification and Intervention
Preventing Adolescent Substance Use Problems
Carol Girard
Massachusetts Department of Public Health
Bureau of Substance Addiction Services
September 27, 2017

2. SBIRT efforts in MA before Mandate
2003/ SBI part of Interagency Council on Substance Abuse Treatment and Prevention’s Strategic Plan
MA law: Mental Health EPSDT/Medicaid
CRAFFT one of approved tools – led to CRAFFT Toolkit  
SAMHSA-funded MASBIRT project included 6 pediatric clinics
BSAS-funded trainings of 32 School Based Health Center Nurse Practitioners
BSAS-funded ED SBIRT & CHC SBI (each included pediatrics)
Present - BSAS-funded MASBIRT TTA
Adolescent provider efforts throughout
2015 New Adolescent toolkit for providers

3. SBIRT in Schools Pilots
DPH School Health Services and Bureau of Substance Addiction Services
2011 Discussions, consultations
School year - 3 pilots from statewide meeting
6/2014 Hilton Foundation advocacy grant to Children’s Mental Health Campaign (Addiction Free Futures) under the MA Society for the Prevention of Cruelty to Children funded through Community Catalyst
pilot schools screening youth in one grade
Pilots included
School meetings
Implementation planning and team building
Team trainings at each school
Boosters with each school team before screening
De-Brief and nurse responses

4. Mandate Highlights Summary
Annual screenings at 2 grade levels -- each city, town, regional school district, charter school or vocational school district must screen pupils for SUDs; 
Pupil or parent/guardian may opt out at any time;
Schools must
Notify parents or guardians prior to the start of the school year;
Use only approved verbal screening tools (CRAFFT II);
Report de-identified results to DPH not later than 90 days after screening completion; 
Complete and report on required ‘substance use disorder’ screenings by the school year.
“Any statement, response or disclosure made by a pupil during a verbal substance use disorder screening shall be considered confidential information and shall not be disclosed by a person receiving the statement, response or disclosure to any other person without the prior written consent of the pupil, parent or guardian, except in cases of immediate medical emergency or a disclosure is otherwise required by state law. “
Consent must be documented on a DPH approved form; not subject to discovery or subpoena in any civil, criminal, legislative or administrative proceeding. “No record of any statement, response or disclosure shall be made in any form, written, electronic or otherwise, that includes information identifying the pupil.” 

5. Lessons Learned: An existing infrastructure has been critical
Planning team
Curriculum
Experienced trainers
Nurse champions ‘Voices from the field’
Web presence with printable forms and other materials, videos and links to materials for youth, parents and teams
Existing registration processes for school nurse trainings/meetings
Aggregate data collection processes in place

6. Lessons Learned: Be flexible within your parameters
Updated training content and materials
Curriculum to conform to mandate
No longer small school teams; individuals
Promote team approach; must rely on teams to form later
Required SBIRT 1 and added optional Essentials
Added contracted (MI) trainers & coordination staff
Created more paper, web, video materials (still in process)
Revised aggregate data collection tools - variables may change or be added making consistent reporting a bit more difficult
Continue to respond to school nurses, counselors, administrators, parents, community coalitions, DAs, national inquiries, media (through our Department), vendors, and others.

7. Lessons Learned: Funding is critical
Jan Pre-mandate supplemental funding
Used for school planning grants through an application process
104 districts participated - one middle or high school from each (5 funded by DAs)
7/16 - 6/18 – Two full years of funding
6/18 – No further funding anticipated
In-kind DPH staff time (extensive still) and resources from 2 DPH Bureaus throughout

8. Funding pays for: Regional Training Sites to accommodate large numbers
Statewide travel costs
Contract Trainers, schedulers, coordination, CNE's, CEUs
Form development and translations into languages
Coordination of local Essentials trainings - very time consuming
Web presence: More videos and written materials
Reprinting of youth and parent prevention materials; contribution for material fulfillment vendor services
Development of ‘evergreen materials’
On line training modules for large numbers of new staff each year starting next school year

9. Caveats
Time: Over 2 years needed to train staff from 344 school districts & ramp up for normalized future annual screenings
Knowledge of school operations and school nurse responsibilities is necessary
Our Director of School Health Services
Nurses/counselors have different roles cultures, and concerns
Schools need to know about local treatment resources and have a central number to call for consultation
School staff will also learn about other issues in students’ lives
Additional agencies, bureaus, groups and vendors may add more complexity - along with resources and ideas
Already community groups asking for data to use for their efforts – small numbers

10. Caveats Communicate early and often Town and state politics:
Be prepared to report regularly on training progress
Open part of training to administrators
Athletics: Coaches may want screening results to cut AOD users from teams
Media: Information may be misrepresented/misunderstood (e.g. drug testing)
All need to deliver clear, consistent messages
Other people/groups may try to join you in the schools
Continue to expect changes and new requests

11. We are still ramping up
No data till next summer/fall Not sure how aggregate data will be presented

12. For further information
MASBIRT Training and Technical Assistance
School Health Institute for Education and Leadership Development