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School SBIRTImplementationReport2023-2024Written by:Tracy Herlitzke, Director, WISH CenterScott Caldwell, SBIRT Consultant, Wisconsin Department of Health ServicesPartnership and funding provided by the Wisconsin Department of Public Instructionwww.wishschools.org Message

SCREENING, BRIEF INTERVENTION,AND REFERRAL TO TREATMENTSBIRT is an efficient, evidence-based, and comprehensive servicefor addressing selected behavioralhealth concerns among middle andhigh school students. Althoughoriginally designed as a universalprevention approach (Tier 1), SBIRT isreadily adapted for delivery byexisting student services staff as aselected (Tier 2) or indicated (Tier 3)intervention. SBIRT delivery is basedon the practice of MotivationalInterviewing.The purpose of this report is todescribe student outcomes andexperiences of participating schoolsin the statewide School SBIRTImplementation Project. Ifinterested, see this report on thehistory, design, and prior outcomesof this unique project. After practitioners completed a two-day initial training or a booster trainingfor those returning, each school teamused the SBIRT Data Dashboard tosystematically record implementationprocess, student screening, briefintervention, and referral data. Theresults described in this report arebased on the aggregated dataset.During the 2023-2024 school year:63 practitioners completed initialtraining20 practitioners completed boostertraining251 students completed initialscreening186 students completed bothinitial and follow-up screening66 students were referred foradditional services40 students (61%) followed throughon the referral Student Change Targets:Mental Health Symptom 32%Conduct Problem 16%Attendance 13%Other Behavior 13%Marijuana 9%Vaping 7%Other Drug Use 4%Missed Academic Work 3%Alcohol 2%1

The averagenumber of Brief Interventionsessions providedper student.IMPLEMENTATIONPROCESS MEASURESStudents were referred to SBIRT from severalsources:Admin-Principal/AP/Dean, 23%School Counselor, 21%Social Worker, 17%Code Violation/ISS/OSS, 17%Other, 7%Student (Self), 7%Parent, 3%School Psychologist, 2%Teacher, 2%Your paragraph textPractitioners whodelivered SBIRT toat least one studentInitial screeningcompletedFollow-up screeningcompletedPractitioner self-assessmentcompletedStudents referred for additional servicesupon completion of the Brief InterventionOf students referred, those whoentered new service88%23%61%74%86%46%2SBIRT wassomething we werelooking for withouteven knowing it.

GAIN-SS Domain% Low Risk% Moderate-to-High RiskInternalizing9%24% + 67% = 91%Externalizing10%26% + 64% = 90%Alcohol/Drug51%19% + 30% = 49%Crime/Violence48%38% + 14% = 52%251 students in grades 6-12 completed an initial Global Appraisal of IndividualNeeds-Short Screen (GAIN-SS) to begin SBIRT. Students showed elevated riskresults across all domains. Rates (%) of moderate-to-high risk for internalizingand externalizing domains showed 91% and 90% prevalence, respectively. SCREENING RESULTS3Additionally, students completed the Timeline Followback (TLFB) Calendarscreening and reported, on average, 15 occurrences of the change target (forexample, occurrence of substance use, mental health symptom, or problembehavior) during the past 30 days.In sum, the overall risk profile suggests SBIRT was an appropriate Tier 2/3intervention for students who needed behavioral health services.

GAIN-SS Domain (0-5 scale)InitialScreening(past 30 day)Average # ofSymptomsFollow UpScreening(past 30 day)Average # ofSymptomsSignificantDifferenceBetweenInitial andFollow Up?Internalizing2.21.6Yes, p < .01Externalizing1.81.6No, p = .12Alcohol/Drug1.00.6Yes, p < .01Crime/Violence0.50.3Yes, p < .05Brief Intervention (BI) outcomes wereexamined for the 186 students (74%of total) who completed both initialand follow up screening. While 251students completed the initial GAIN-SS, this analysis focuses only on thosewith follow-up data. Analysisshowed a statistically significantand robust BI effect. Studentsshowed, on average, reducedfrequency of the change target andfewer problem symptoms from initialto follow up screening.BRIEF INTERVENTION OUTCOMESBI significantly reduced student problem symptoms across most domains.4BI significantly reduced frequencyof the student change target.15.29.637%ReductionInitial TLFBFollow upTLFB

There were three distinct groups of student response to BI: Improvers (n = 109, 60% of total) showed an averagedecrease of symptoms; Decliners (n = 56, 30%) showed an average increase ofsymptoms; and No Changers (n = 18, 10%) showed no change insymptoms from initial to follow up screening. BRIEF INTERVENTION OUTCOMES5Students who self-referred to SBIRT(n = 21) experienced the greatestimprovement with, on average, 1.3fewer problem symptoms from initialto follow up screening. In contrast,students referred from anunspecified “other” source (n = 17)showed the least improvement with,on average, one more problemsymptom. Self-referred students mayhave responded particularly well toBI due to existing motivation forchange.0-1-2 0 1 2 3Student (Self)Student ServicesAdministratorParentCode ViolationOther1.30.480.420.130.10-1.05Analysis of student improvers showed several findings:On average, middle school and high school students showed similar improvementin response to BI.On average, number of BI sessions was 4.Average length of time from practitioner initiating consent with parent to studentstarting SBIRT was significantly less for improvers (7 days) compared to decliners (15days) or no changers (22 days).At initial screening, student improvers showed significantly more problemsymptoms compared to decliners or no changers. Practitioners of student improvers were more likely to focus BI on behavioral healthconcerns (such as mental health, substance use, or conduct) versus school-basedconcerns (such as attendance or academics).ImproversDeclinersNo Chan…60% 30%10%Referral source seemed to matter in Brief Intervention outcome.Decliners | Improvers

Summary of Key FindingsConsistent with prior statewide evaluations, School SBIRT continues to showpositive results for most student participants.SBIRT was particularly effective for students who presented with moreproblem symptoms, for students who were self-referred, and for studentswith whom practitioners delivered BI focused on behavioral health concernsversus focus on school-based concerns.With the high prevalence of risk in the initial GAIN-Short Screen, SBIRTcontinues to be a useful Tier 2/3 intervention to address student behavioralhealth concerns from multiple referral sources. Following completion of BI, 66 students were referred for additional services. Rateof referral by student response group was 24% for no changers, 36% forimprovers, and 42% for decliners, but these differences did not reach statisticalsignificance (p = .38). Students who were referred had significantly more problemsymptoms and showed more frequency of the change target in the follow upscreening compared to students who were not referred. Most students (n = 40,60.6% of total referred) followed through on the referral to enter the new service.These students were originally referred to SBIRT primarily by student services (40%)or an administrator (25%).REFERRAL TO TREATMENT6

We asked practitioners to share the story of their SBIRT workduring the 2023-2024 school year. Watch the short videobelow to hear their thoughts.WISCONSIN SCHOOL EXPERIENCES IN THESBIRT IMPLEMENTATION PROJECT 7“Students have said that they don't feel "judged" or "pushed" but feel likewe are really interested in helping them be successful and meet a goal oftheir choosing without judging.”“One of the key strengths of SBIRT is its adaptability to different student needs.”“We had a student this year that was significantly struggling with impulsecontrol, to point that he at times wasn't even aware of his actions...he wasfailing all his classes...The SBIRT process led to a referral to the studentsphysician... The students family was able to work with medical professionals tofind an appropriate medication ... The student continued to work with theschool counselor... By the end of the school year, the student was able to passall classes with B's and C's. He strengthened his friendships with peers and wasable to participate successfully on the track & field team.”“It was amazing to see that students really did want to make... changes.”“SBIRT has been successful at reducing student vaping at our middle school.”Video by Jenny Holle, WISH Center, Regional Coordinator. Watch on Youtube.

GUIDANCE FROM SCHOOL TEAMS THATSUCCESSFULLY IMPLEMENTED The Implementation Process:Allocate adequate time to practice and find the bestprocesses and procedures for implementation.Create a strong system to identify the right kids anddesignate time to meet with them.Continuing to increase the amount of practitionersinvolved in SBIRT. Those that volunteer, not voluntold.Educate and continue to communicate withadministration on why SBIRT is important.The ongoing Community of Practice is very helpful!Using the SBIRT Data Dashboard (within each school):It helps the practitioner focus on student progress,intervention impact, and need for additional services.Completing the dashboard was a really useful self-evaluation.A tool to monitor and connect with SBIRT practitioners intheir buildings.Complete it "in real-time" by setting aside 20 minutes eachweek for updates.Use it to determine what behaviors to use it as anintervention for (AODA, mental health, etc.).Use it to track referrals for additional support/services.We could see what was going on and we could hold eachother accountable for using SBIRT.(SBIRT) providesconsistency inour interventionprocess.SBIRT has reallyhelped provide somestructure to how weprovide supportversus just theconsequence when astudent has beensuspended.8“The data dashboardwas a tool used foraccountability,collaboration,continuousimprovement, andanalysis of patternsand trends.”

The Wisconsin Safe and Healthy (WISH) Schools Training &Technical Assistance Center is a collaboration between theCESA Statewide Network and the Wisconsin Department ofPublic Instruction as a state-wide delivery mechanism to buildthe capacity of educators to positively impact the well-beingand equitable outcomes of every student.Learn more about the School SBIRT Implementation Project onour website: www.wishschools.org/resources/schoolsbirt.cfmThe WISH Center works in collaboration with the WisconsinDepartment of Health Services and Wisconsin Department ofPublic Instruction to provide training, implementation support,and evaluation of School SBIRT.ABOUT THE WISH CENTERA sincere thank you to thepractitioners whoimplemented School SBIRT,served students, and sharedthe data and feedback thatcomprised this report.Partnership and funding provided by the Wisconsin Department of Public Instruction.Data analysis and reporting provided by the Wisconsin Department of Health Services.9