title: Barriers to Addressing Adolescent Substance Use: Perceptions of New York School-Based Health Center Providers.
abstract: BACKGROUND
  Adolescent substance use is associated with chronic health conditions, accidents, injury, and school-related problems, including dropping out. Schools have the potential to provide students with substance use prevention and intervention services, albeit with confidentiality challenges. School-based health centers (SBHCs) provide confidentiality, positioning them as ideal settings to provide substance use prevention and intervention. This study identified program directors' and clinicians' barriers to addressing adolescent substance use in SBHCs.
  
  
  METHODS
  Between May and June 2013, an electronic survey was distributed to all 162 New York State SBHC program directors and clinicians serving middle and high school students.
  
  
  RESULTS
  The most prevalent perceived barriers to discussing substance use with students were time constraints (43%), the belief that students are not honest about their use (43%), and clinicians' lack of training (28%). Both directors and clinicians identified challenges in getting students to return for additional sessions to address their use, and they also indicated that confidentiality was a treatment referral barrier.
  
  
  CONCLUSIONS
  This study identified timely opportunities that may be leveraged and unique challenges that may be overcome with targeted dissemination, training, and technical assistance efforts to enable directors and clinicians to routinely address substance use in SBHCs.
authors.affiliation: Health Policy, Management, and Behavior, University at Albany School of Public Health, Rensselaer, NY 12144. brh24@cornell.edu.
authors.forename: Brett
authors.initials: B
authors.lastname: Harris
authors.affiliation: Health Policy, Management, and Behavior, University at Albany School of Public Health, Rensselaer, NY 12144. bashaw@albany.edu.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Shaw
authors.affiliation: University at Albany School of Social Welfare, Albany, NY. hlawson@albany.edu.
authors.forename: Hal
authors.initials: H
authors.lastname: Lawson
authors.affiliation: Health Policy, Management, and Behavior, University at Albany School of Public Health, Rensselaer, NY 12144. bsherman@albany.edu.
authors.forename: Barry
authors.initials: B
authors.lastname: Sherman
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D016497:Adolescent Health Services; D000328:Adult; D000368:Aged; D005178:Faculty; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York; D010465:Perception; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012572:School Health Services; D012574:Schools; D019966:Substance-Related Disorders / Q000517:prevention & control / Q000523:psychology / Q000628:therapy; D055815:Young Adult
keywords: adolescents; perceived barriers; school-based health centers; substance abuse