title: Screening, brief intervention, and referral to treatment for adolescents: Attitudes, perceptions, and practice of New York school-based health center providers.
abstract: BACKGROUND
  Screening, brief intervention, and referral to treatment (SBIRT) has been endorsed by the American Academy of Pediatrics as an evidence-based strategy to address risky substance use among adolescents in primary care. However, less than half of pediatricians even screen adolescents for substance use. The purpose of this study was to identify variation in SBIRT practice and explore how program directors' and clinicians' attitudes and perceptions of effectiveness, role responsibility, and self-efficacy impact SBIRT adoption, implementation, and practice in school-based health centers (SBHCs).
  
  
  METHODS
  All 162 New York State SBHC program directors and clinicians serving middle and high school students were surveyed between May and June of 2013 (40% response rate).
  
  
  RESULTS
  Only 22% of participants reported practicing the SBIRT model. Of the individual SBIRT model components, using a standardized tool to screen students for risky substance use, referring students with substance use problems to specialty treatment, and assessing students' readiness to change were practiced least frequently. Less than 30% of participants felt they could be effective at helping students reduce substance use, 63% did not believe it was their role to use a standardized screening tool, and 20-30% did not feel confident performing specific aspects of intervention and management. Each of these factors was correlated with SBIRT practice frequency (P < .05).
  
  
  CONCLUSIONS
  Findings from this study identify an important gap between an evidence-based SBIRT model and its adoption into practice within SBHCs, indicating a need for dissemination strategies targeting role responsibility, self-efficacy, and clinicians' perceptions of SBIRT effectiveness.
authors.affiliation: a Department of Health Policy, Management, and Behavior, School of Public Health , State University of New York at Albany , Rensselaer , New York , USA.
authors.forename: Brett R
authors.initials: BR
authors.lastname: Harris
authors.affiliation: a Department of Health Policy, Management, and Behavior, School of Public Health , State University of New York at Albany , Rensselaer , New York , USA.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Shaw
authors.affiliation: a Department of Health Policy, Management, and Behavior, School of Public Health , State University of New York at Albany , Rensselaer , New York , USA.
authors.forename: Barry R
authors.initials: BR
authors.lastname: Sherman
authors.affiliation: b School of Social Welfare , State University of New York at Albany , Albany , New York , USA.
authors.forename: Hal A
authors.initials: HA
authors.lastname: Lawson
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services; D000328:Adult; D000368:Aged; D055317:Evidence-Based Practice; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York; D011614:Psychotherapy, Brief; D012017:Referral and Consultation; D012572:School Health Services; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000628:therapy*; D055815:Young Adult
keywords: Adolescents; evidence-based practice dissemination; implementation; school-based health centers; screening, brief intervention, referral to treatment (SBIRT); substance abuse