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The adolescent Screening, Brief Intervention, Referral to Treatment (SBIRT) - School-Based Health Center (SBHC) Project is a five-year collaborative venture between the Colorado Department of Human Services - Office of Behavioral Health (CDHS-OBH) and the Colorado Department of Public Health and Environment (CDPHE). Funding is being administered through the Office of Behavioral Health to the Colorado Department of Public Health and Environment to CDPHE-funded school-based health centers (SBHC) around Colorado in order to institutionalize SBIRT as a standard of care into existing CDPHE-funded SBHCs who are voluntarily participating in this project.
Adolescent SBIRT is a research-based approach to the identification of risky substance use and provides brief interventions and referral to treatment to those at risk of developing substance use problems. SBHCs are convenient medical clinics that offer health care to children and youth either in a school or near school grounds. SBHCs have primary care providers such as doctors, nurse practitioners and physician assistants, as well as mental health providers.
This SBIRT-SBHC project funding is supporting SBHCs across the state by:
OBH funding for this project started Sept. 10, 2017. The funding was $1,037,000 for the first year and increased to $1,310,371 in year two. Funding will continue at $1,310,371 in years three, four and five.
SBIRT-SBHC ResourcesSBIRT-SBHC Project Website
SBIRT-SBHC Annual Summary
Fiscal Year 2017-18Issued December 2018
SBIRT-SBHC Needs and
Readiness AssessmentIssued May 2018
SBIRT-SBHC Strategic and Eval PlanIssued December 2018
A 13-15 member SBIRT Steering Committee has been assembled to inform a comprehensive, systems integration of SBIRT into school-based health centers. Learn more about the members of steering committee here.
SBIRT is Screening, Brief Intervention, Referral to Treatment, an evidence-based prevention practice developed by the World Health Organization to address unhealthy alcohol and other drug use among adult and adolescent patients. The United States Preventive Services Task Force, the Centers for Disease Control and other expert groups recommend SBIRT as a routine part of health care.
Screening (S): Uses validated questions, self-administered by patients or administered by a member of the health care team, to determine quantity and frequency of alcohol or other drug use. Electronic screening formats are available. Screening results and patient characteristics such as age, gender and health status determine the level of intervention needed. Learn more about validated screening tools at ImprovingHealthColorado.org.
Brief Intervention (BI): A brief 5-10 minute conversation with patients at-risk for health or other negative consequences of alcohol or drug use. The brief intervention uses motivational interviewing to provide feedback, explore ambivalence, enhance motivation to change, and collaborate with the patient to set a goal to cut back or in some cases entirely quit using alcohol or drugs. Linking feedback and encouragement to change alcohol or drug use to a patient’s chief concerns or health problems may increase effectiveness. Even one brief intervention may lead to change. Multiple brief interventions are often more effective.
Referral to Treatment (RT): Provided to patients who report higher risk alcohol or drug use or meet criteria for a severe alcohol or drug use disorder. A referral typically includes further evaluation by a specialist, and specialized services such as counseling and in some cases medications to address alcohol and drug use and co-occurring health or mental health problems. Follow-up and ongoing care coordination is essential for effective referrals. Find resources at ImprovingHealthColorado.org.
The evidence for SBIRT is strongest as an early intervention approach to address alcohol use in adults who do not have a severe alcohol use disorder. It is a promising practice in adolescents to address tobacco, alcohol, marijuana and other drug use. As part of comprehensive preventive services, SBIRT can improve health outcomes and quality of life. Follow-up data from clinics and hospitals in Colorado that provided SBIRT demonstrated clinically meaningful decreases in at-risk alcohol, marijuana and other drug use after a brief intervention provided by a health educator. SBIRT may produce cost savings for health care systems by reducing use of emergency and in-patient services, and improving health outcomes. Read more about preliminary cost savings and recommendations for SBIRT in Colorado in the SBIRT Cost Analysis Report and SBIRT Assessment with Recommendations Report.
An interdisciplinary team approach is the most efficient way to provide SBIRT. For example, a medical assistant may initiate screening and record the results in the electronic medical record. Brief preliminary screening questions can be included as part of the intake process similar to brief screening for tobacco use or depression. Patients with a positive brief screening result may receive further screening with a validated questionnaire such as the AUDIT for alcohol use. Routine screening may occur annually or at every visit like a vital sign, which is often the most efficient approach.
Different members of the health care team may provide the brief interventions including primary care practitioners, social workers, nurses, health educators, or other team members. Arranging referrals for further assessment and treatment of more serious alcohol or drug use problems, follow-up and ongoing care coordination are most effective when carried out by a multidisciplinary care team.
SBIRT is covered by Medicaid in Colorado, Medicare and some commercial health plans. Learn more at www.colorado.gov/hcpf.
Although initially developed as a primary care prevention practice, SBIRT has been successfully implemented in many settings including, emergency departments, inpatient hospital units, schools, college health centers, employee assistance programs, mental health centers and others.
SBIRT Colorado (SBIRT CO) was funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) in two consecutive 5-year grants from 2006-2016. This funding was administered by the Colorado Department of Human Services, Office of Behavioral Health, implemented by Peer Assistance Services and evaluated by the OMNI Institute.
These are core highlights from 10-years of SBIRT:
To learn more about this interagency collaboration, SBHCs SBIRT, contact:
Jodi Lockhart, Community Prevention Programs Manager
Office of Behavioral Health
email@example.com | 303.866.7497
Kristina Green, SBIRT Project Coordinator
Colorado Department of Public Health and Environment
firstname.lastname@example.org | 303.692.6279