Success Story

How King County’s School Districts Used SBIRT to Improve Detection and Management of Mental Health and Wellness

Problem

Effectively Identifying & Treating Youth Struggling with Mental Health.

Schools in King County, Washington, like schools across the US, carry much of the burden of poor youth mental health. The 2018 Healthy Youth Survey found 16% of 8th and 12th graders in King County had made a suicide plan in the last year, and 8-9% of all students had attempted suicide.

Students contemplating suicide are suffering, often silently, and many slip through cracks in the support available in schools and elsewhere.  Poor mental health has an overall effect on community wellbeing and impairs school performance, attendance rates, and graduation rates– all of which can negatively impact school funding. Lack of school funding impedes the ability to provide services and sets in motion a negative spiral for the entire community and wellbeing of the student body.

With the approval of the Best Starts for Kids (BSK) program in 2015, King County schools got to work improving mental health outcomes in its middle & high schools, and the health of the community. In partnership with community groups like Reclaiming Futures and Youth Eastside Services, King County’s Department of Community and Human Services implemented a school-based Screening, Brief Intervention and Referral to Treatment (SBIRT) program in 42 middle & high schools to identify and treat students suffering from mental health issues and potential misuse of substances.

“In partnership with community groups like Reclaiming Futures and Youth Eastside Services, King County’s Department of Community and Human Services implemented a school-based Screening, Brief Intervention and Referral to Treatment (SBIRT) program in 42 middle & high schools.”

Solution

School-Based SBIRT Using Check Yourself© Powered by Tickit®

SBIRT is an evidence-based three-pronged approach that identifies those at risk and triages them to appropriate care, using a brief counselling intervention or referrals for more serious issues. King County partnered with Seattle Children’s Research Institute (SCRI) to design a research-based screening tool for the specific population of students and areas of focus. To optimize the effectiveness of the SBIRT program, SCRI and King County solicited the help of Tickit Health to create the Check Yourself screener, which asks about substance use, lifestyle, mental health and adverse childhood experiences. It looks at possible sources of strength and self-empowerment following a trauma-informed child and youth-friendly framework. Tickit Health’s Digitally Empathetic approach to capturing information from vulnerable populations was of particular value to King County and the SCRI researchers.

Each of the 42 schools determined the screening implementation policies that best suited their specific school’s needs. The vast majority of students participated even though participation wasn’t mandatory. Some chose opt-in policies, while others made the screener opt-outable. Most districts began the SBIRT implementation in December 2018.

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Students completed the school-based Check Yourself tool

“Last year we had a number of completed suicides in the greater Eastside and they weren’t kids people would traditionally call up in their head and think of as being at risk. The screener will help us find kids that are less obvious and get them the help they need before something happens.”

– Youth Eastside Services’ COO David Downing to the Kirkland Reporter

Through Tickit’s Check Yourself tool, King County schools efficiently implemented SBIRT across a large population of students. Universal screenings connected kids who were not previously identified as needing support to interventions and referrals. Because of Tickit’s Digitally Empathetic approach, students were more forthcoming with information, so students previously unidentified as being at risk were now identified as needing help.

Based on the results of the screening, Check Yourself, powered by Tickit, designated students as low, moderate, or high risk based on behaviours they conveyed in the screening. School-based interventionists then conducted a Brief Intervention of 15- 20 minutes with the moderate and high-risk youth to assess strengths, facilitate goal-setting, provide referrals, and follow-up as needed. Students who needed it were then given a referral to services through school-based services or community partners.

Impact

Improved Detection and Treatment of Child and Youth Mental Health

Through Tickit’s Check Yourself tool, King County schools efficiently implemented SBIRT across a large population of students. Universal screenings connected kids who were not previously identified as needing support to interventions and referrals. Because of Tickit’s Digitally Empathetic approach, students were more forthcoming with information, so students previously unidentified as being at risk were now identified as needing help.

SBIRT connected 37% of students who were screened to brief interventions and 15% were referred to community services. Students overall found their experiences with counsellors satisfying: 91% of students felt their interactions during the brief interventions were “good”, “very good” or “excellent”. Counsellors were more effective during the Brief Interventions as they had more complete information on each student.

Even without interventions, the digital screening powered by Tickit helped students feel more connected to the school community. One SBIRT interventionist commented, “Just knowing that we care enough to have the screener, and the way the questions are geared towards their developmental level, says ‘we care about you, and we want to know how we can support you.’”

Finally, the Digitally Empathetic design screenings were age appropriate and engaging. The Tickit Check Yourself tool identified students needing support and streamlined the school processes for connecting them to supports. In future years, King County schools will expand this program and use it to identify mental health needs stemming from COVID-19

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Reported higher school connections after participating in school-based SBIRT

12.5% of students had risk factors that were not known to staff prior to screening.

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