What is the research about?
Alcohol use in young people is linked with many negative outcomes, including increased risk for car accidents, unwanted pregnancy, violence, disengagement from school, psychiatric illness, and addiction. Fortunately, progression of alcohol use is preventable, and schools are critical in addressing use before it becomes a problem. Many schools are leveraging lessons learned from medical settings by implementing the Screening, Brief Interventions, and Referral for Treatment (SBIRT) framework as a way of improving early detection and intervention. SBIRT includes administering a validated screening instrument to all students and then, based on responses on the screen, delivering a brief intervention (BI) to increase motivation to reduce alcohol use.
While SBIRT is an important step forward in harnessing the power of schools to promote youth health and well-being, limitations in how BIs are currently implemented exist. First, robust BIs are typically only delivered to youth who have already begun drinking at risky levels. This may result in most youth falling through the cracks and is at odds with the science on the importance of intervening early in the substance use trajectory. Second, most schools rely on nursing and/or clinical staff to deliver BIs. However, this workforce is already strained. Other fields have shown promise in expanding traditional SBIRT workforces to include paraprofessionals, including peers, mentors, and other nonclinical service providers, to reduce burden and reach a greater number of individuals. Finally, minoritized youth are at greater risk for negative alcohol-related outcomes, yet there has been little work to date to ensure BIs are as effective in these populations.
Who can this research help?
School and district administrators can use this information to implement SBIRT in a way that is most effective in preventing and reducing alcohol use, scalable given infrastructure limitations, and equitable. Policy makers and insurance administrators can use findings to learn about ways to best support youth gaining access to substance use prevention in schools. Researchers may also be able to develop more informed hypotheses based on the qualitative data with minoritized youth to be tested in future studies. These studies will be critical in reducing disparities in the effectiveness of school-based interventions.
What is the research team doing?
The research team is working with 40 public high schools across Massachusetts to enroll 1,500 youth participants in grades 9-11 with past-year alcohol use as reported on an annual SBIRT screening survey. The study involves an overrepresentation of high-need schools. The team is assigning schools, by chance, to one of four conditions that describe how BIs will be delivered as part of SBIRT:
- BIs will be delivered to youth with risky drinking by nursing/clinical staff. This is the current standard practice in schools.
- BIs will be delivered to youth with risky drinking by an expanded SBIRT workforce involving nursing/clinical staff and trained, supervised paraprofessionals.
- BIs will be delivered to youth with and without risky drinking by nursing/clinical staff.
- BIs will be delivered to youth with and without risky drinking by an expanded SBIRT workforce involving nursing/clinical staff and trained, supervised paraprofessionals.
The team is assessing participants at baseline (at the time of the SBIRT screening survey) and every three months over a 12-month period to see if they are drinking alcohol, using other substances, having problems from use, and experiencing symptoms of depression and/or anxiety. The team will conduct focus group interviews with a smaller number of minoritized participants enrolled in the larger study, including those who are a racial or ethnic minority student, LGBTQ+, and/or learning English. Interviews will be conducted at the time of the SBIRT screening survey and after 12 months to learn about factors that may contribute to different responses to BIs for alcohol use.
What stakeholders are involved?
This study will be jointly led by a team of key stakeholders including scientists, policy makers, public health advocates, principals and superintendents, parents, and youth. The team will leverage partnerships and support from Substance Abuse and Mental Health Services Administration’s Mental Health Technology Transfer Center, the Massachusetts School Mental Health Consortium, and the Bureau of Substance Addiction Services at the Massachusetts Department of Public Health (Massachusetts’ Single State Agency) for broad dissemination of findings to the people and communities who will benefit most.
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.