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SBIRT in Norwood City Schools—the First Year

Norwood City Schools in Norwood, Ohio began using SBIRT during the 2014-2015 school year to help identify students with substance abuse problems. To our knowledge they are the first school in Ohio to implement an SBIRT program. Deb Robison, Director of Family and Student Services, answered our questions about how their project was launched, how students responded, and how they will continue using SBIRT next year.

(1)  What prompted Norwood to begin the SBIRT project? We were not having much luck finding students with substance abuse (SA) problems before they were being expelled and out of our reach. Staff were reluctant to make SA referrals for fear of being wrong about their referral. Parents were reluctant to follow through on referrals due to not believing their student was participating in drug use. We knew from our data that approximately 30% of our high school students were using alcohol on a somewhat regular basis. At that time, Interact for Health [a foundation serving the Greater Cincinnati area] was calling for proposals to do SBIRT projects in the medical field. Along with our partners at Prevention First! we thought we could try something unique by doing SBIRT screenings at the same time we did other medical screenings in the schools.

(2)  How did community partnerships improve the project? We could not have done this without community partners. First, our Drug and Alcohol Coalition was the catalyst for thinking about different ways to intervene early. Next, we engaged our local Norwood Health Department (NHD) as a medical partner. NHD does prevention work and screenings in the schools, such as dental screenings and tobacco cessation. They were trusted partners and the school was able to develop Memoranda of Understanding (MOUs) and information sharing protocols for working together.

We already work with Talbert House, a community mental health agency. They worked with us to assign a drug and alcohol therapist whose specific role included doing some of the screenings, brief intervention, treatment, and case coordination.

Our next partner was Prevention First! They assisted with the grant writing, accessing training, and development of a toolkit (still in progress) so that we can share lessons learned with other schools.

Obviously, Interact for Health has been a huge partner, both for funding and technical assistance. They provided us with an excellent evaluator that helped us to develop a process for looking at the outcome of our collective work. It is important to know that on the school end, this was a partnership between health services and family and student services. There were a lot of players involved with bringing this to fruition.

(3)  How did you involve the community, particularly parents? We did some work on the front end to prepare people. We shared with school administration and the school board the process and our hope that SBIRT would help us find students who were struggling and offer them help. We showed them the process and answered questions about how much time it would take, confidentiality, and other questions.

Next, we put an article in our local community newspaper announcing the grant as well as the process for what we termed the “conversational screening” for alcohol use. Finally, the screening information was listed in the enrollment packet along with all other screenings (hearing, vision, scoliosis, dental, etc.) with the passive permission for the school to conduct the screenings. In other words, parents were to sign the form and return it if they did NOT want their child screened. We did not receive any declinations.

We trained school staff through our School Safety Training website. There are several annual trainings that staff must complete. We developed a very short (less than five minute) training on SBIRT, and all staff are required to complete this training.

(4)  How did students respond? Most students really had no response. They answered the questions and went on with their day. A few were hesitant at first. We assured students that they were not in trouble for their answers and that we would not be leveraging any disciplinary procedures. Some were quite honest about their use and that of their friends. Others seemed to be not as forthcoming. We expected that, though, and knew that some students would not be honest with us. We saw this as both an intervention tool and a prevention tool. Our hope is that young people know that there are adults who care about them, and by asking about alcohol use in a non-accusatory manner, we developed some relationship credibility. We hope that if a student decides he/she wants help or has a friend who needs help, they know where to go. In fact, we did have a student who told us he did not use. Then a few weeks later he approached the social worker who had screened him and said that he hadn’t been honest with her and asked for help. We connected him with our Substance Abuse counselor.

(5)  What do you think the biggest impact was on students? See above regarding relationships. It seems to me that if we start the conversations with young people and continue to have them, we can make an impact. We know that we identified about 29 students, most of those 9th graders, for further services. That is about 5% of all that we screened. (See below for a table of the numbers of students in each grade who were screened and/or identified positive for SA use.) We anticipated screening about 10% positive for SA use. We believe that as we continue, we will see that screening number go up before it heads back down. 

(6)  What was the biggest challenge? Really, it was just first year challenges. Figuring out how many kids to call at a time. Establishing rapport with a student prior to the first screening question (e.g. “Great shirt! Are you a Bengals fan?”) Some logistical concerns with MOUs and how to allow the health department to access some, but not all information. How as a school we could access that information if the Health Department “owned” the data. We also struggled somewhat with the brief intervention piece. We did well with level one (no problem, encourage the student to continue) and level 3 (highly indicated and referral for treatment), but we have to work on how we will do level two, a brief intervention, and who will do it. We have been working on that, though. We also found that we needed to be very intentional about assigning someone the responsibility of following up with a family.

(7)  Will you be doing SBIRT again in 2015-16 school year? Any changes? Yes, we will be doing it again. We are no longer grant funded but believe we can continue. We strategically had many screeners trained on the front end so that we could continue. It is time intensive for a few days of the year, but it is quite doable in our school setting. The health department has agreed to help with the screening, but our school social worker will have a bigger role. Additionally, we will take the lessons learned about follow-up and implement those in our processes. We will continue to screen 6-9th graders but may add 10th grade since these students were 9th graders last year and would have been screened.

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