Even before the pandemic, in 2019, the National Academies of Sciences, Engineering, and Medicine issued a call to action to prioritize the growing mental, emotional, and behavioral needs of youth in the United States. The risk is high; 1 in 5 youth aged 13 to 18 have or will develop a serious mental illness in their lifetime. Much of this morbidity is preventable with early intervention. However, with current standard approaches to care, only half of adolescents with depression are identified before becoming adults. School-based Screening, Brief Intervention and Referral to Treatment (SB-SBIRT) is a methodology used in early prevention for students prior to the development of a substance use disorder, and it now considered a strategy for mental health screening and management.
Targeted versus Universal Screening
Traditionally, screening was performed in a targeted manner. Young people struggling were identified by parents or teachers before taking a mental health screening assessment to evaluate their problems more objectively. While the model works, many children and youth are not identified and fall through the cracks.
Universal school-based SBIRT incorporates screening for substance use with mental health symptoms as well as strengths and protective factors in the context of a multi-tiered system of support (MTSS) framework. The approach addresses the needs of the entire school population holistically, to engage a broader system of resources and support including school staff and caregivers and to address the urgent and emergent issues of students who were previously unidentified as facing mental health challenges.
Why Schools are the Best Place for SBIRT
Youth spend a large majority of their time in school, making schools an ideal location to support youth. Schools can help support the psychosocial needs of their students through developing connections with school and community supports and services. They are uniquely invested in the health, education, and overall well-being of youth and can be a critical partner in addressing youth mental health and substance use.
Additionally, schools are well set up for using the same technology with every student, allowing for efficient processes in implementation and management. Purpose-built technology (child and youth friendly and strengths-based) screening assessments combined with school focussed streamlined workflow are important considerations for successful implementation.
Universal Screening Improves Performance
In addition to streamlining counselling services, data captured can be used to improve accountability, inform resource allocation, and enhance the development of whole school prevention programming. Combining universal risk screening with strengths-based Digital Empathy can have positive impacts to youth academic performance including improving attendance and grades and decreasing the frequency of disciplinary actions like suspensions and expulsions. It provides a means to identify a student who could benefit from receiving brief intervention and is a strong starting point for conversations with students.
A Success Story
In 2018, King County, Washington partnered with Tickit Health and Seattle Children’s Research Institute to launch a universal digital screening and SBIRT program in 50 middle schools. The purpose-built Digitally Empathic platform and proprietary screening tool, Check Yourself, was used universally. More than 8,000 students participated in the program in its second year and the county is on track to reach 5,000 students this year, even though most schools transitioned to online learning during the pandemic.
Check Yourself includes embedded validated screeners to detect symptoms of at-risk behaviours, combined with strengths based carefully crafted indicators such as, “At school there is an adult who really cares about me,” or “Others have said that I am good at …” to gather information about more protective factors such as strength and resiliency.
Using at-a-glance analytics through a dashboard, school counsellors monitor and triage students in real time, resulting in efficient and streamlined intervention when needed. A green flag means no intervention is required, a yellow flag indicates the need for a brief intervention of a non-urgent nature, and a red flag alerts to concerns that must be addressed immediately or within 24 hours. Nearly half of participating students received brief intervention, and 15 percent were referred to services. Counsellors uncovered a vulnerable group who would normally be extremely difficult to identify: internalizers, those students who appear to be doing great on the surface but are harbouring unsafe thoughts.
Staff felt empowered and acknowledged about the impact of their work. Students reported that the screening improved their connectedness to the school and community. Families felt more engaged. Altogether, the King County pilot was a win, win, win.
For more information,
read our case study on King County.