While the value of SBIRT can be measured using “tangibles” like billing, there are broader cultural benefits that are sometimes more challenging to quantify, but equally, if not more, important. Overall, providing SBIRT in the school-based health setting can create meaningful shifts in both the culture of the SBHC and of the school. Implementing SBIRT can change the way we as individuals and providers understand and talk about substance use, reducing stigma, increasing prevention, and interrupting potential long-term health effects. For example, universal screening can lessen stigma around disclosing substance use. It can help school staff and SBHC providers view substance use as a healthcare issue requiring treatment versus traditional punishment, and it can start conversations about the non-linear nature of behavior change and recovery. SBIRT can also delay or interrupt early use that has preventive aspects for addiction and related health issues across a lifespan. Therefore, it is important to keep these potential non-financial benefits in mind when talking with SBHC staff and the school community about the value of SBIRT.
Documenting the value of SBIRT can help to ensure ongoing integration into clinic services, as well as improvement and sustainability of the program in schools. To prove this value, SBHCs should implement a data collection system and protocols to evaluate SBIRT implementation and outcomes. SBHCs should also use data to implement a quality improvement system to monitor and improve the efforts and effectiveness of their SBIRT services.
To collect data, SBHCs should ideally have a robust electronic health record (EHR) or other practice management system to capture both process and outcome measures of SBIRT implementation.
Process data may include demographic information on clients screened for substance use; screenings conducted and corresponding results; referrals made to SBHC and/or external providers; and SBHC services received to address screening results. This data can help to answer the following evaluation questions:
- Which clients are receiving screenings?
- What percentage of clients are screened?
- What percentage of screens are positive?
- What percentage of positive screens receive referrals to SBHCs and/or external services?
- Did SBHC billing revenue increase after SBIRT implementation?
Outcome data may include attitudes or behaviors that are tracked over time, such as frequency of substance use or self-reported confidence in limiting substance use. SBHCs can also measure the impact of SBIRT implementation on their clinicians, including changes in knowledge and attitudes towards implementing SBIRT. This data can help to answer the following evaluation questions:
- Do clients who receive SBIRT interventions report reduced substance use?
- Do students and school staff report reduced stigma related to discussing and addressing youth substance use?
- Are SBHC clinicians more confident in their ability to implement each component of SBIRT?
To analyze the data, SBHCs should regularly export, analyze, and summarize the evaluation data for reporting to SBHC staff, funders, public policy makers, education partners, and other child health stakeholders. Findings should be presented in meaningful, compelling, and social and economic terms to support effective implementation and further the evidence base.
SBHCs should also use data to implement a quality improvement system to monitor and improve the efforts and effectiveness of their SBIRT services. SBHC staff should meet regularly as a team to review the data described above to ensure that they accurately reflect the efforts implemented in the SBHC. They can discuss the following questions:
- Are percentages of screenings conducted reflective of the actual screening protocols and efforts of the SBHC staff?
- Are screenings, services provided, and referrals being documented accurately?
SBHC administrators and providers should then implement necessary improvements in protocols and practices based on these data. They can discuss the following questions:
- Can percentages of clients screened be increased if a reminder is incorporated into the EHR when annual screenings are due?
- Can billing revenue be increased with additional staff training?
- Evaluation and QI recording from Sara and Samira
- Ask Paula and S+S for recommendations about general evaluation and QI resources. I’m thinking less research, more practical tools/frameworks
- School-based SBIRT process eval final report from King County