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Screening in school-wide positive behavior supports: methodogical comparisons

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Many schools have adopted programming designed to promote students' behavioral aptitude. A specific type of programming with this focus is School Wide Positive Behavior Supports (SWPBS), which combines positive behavior

Many schools have adopted programming designed to promote students' behavioral aptitude. A specific type of programming with this focus is School Wide Positive Behavior Supports (SWPBS), which combines positive behavior techniques with a system wide problem solving model. Aspects of this model are still being developed in the research community, including assessment techniques which aid the decision making process. Tools for screening entire student populations are examples of such assessment interests. Although screening tools which have been described as "empirically validated" and "cost effective" have been around since at least 1991, they have yet to become standard practice (Lane, Gresham, & O'Shaughnessy 2002). The lack of widespread implementation to date raises questions regarding their ecological validity and actual cost-effectiveness, leaving the development of useful tools for screening an ongoing project for many researchers. It may be beneficial for educators to expand the range of measurement to include tools which measure the symptoms at the root of the problematic behaviors. Lane, Grasham, and O'Shaughnessy (2002) note the possibility that factors from within a student, including those that are cognitive in nature, may influence not only his or her academic performance, but also aspects of behavior. A line of logic follows wherein measurement of those factors may aid the early identification of students at risk for developing disorders with related symptoms. The validity and practicality of various tools available for screening in SWPBS were investigated, including brief behavior rating scales completed by parents and teachers, as well as performance tasks borrowed from the field of neuropsychology. All instruments showed an ability to predict children's behavior, although not to equal extents. A discussion of practicality and predictive utility of each instrument follows.

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  • 2012

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Screening, Brief Intervention and Referral to Treatment (SBIRT): Implementation in the Adolescent Inpatient Psychiatric Setting

Description

Background: The cost of substance use (SU) in the United States (U.S.) is estimated at $1.25 trillion annually. SU is a worldwide health concern, impacting physical and psychological health of

Background: The cost of substance use (SU) in the United States (U.S.) is estimated at $1.25 trillion annually. SU is a worldwide health concern, impacting physical and psychological health of those who use substances, their friends, family members, communities and nations. Screening, Brief Intervention (BI) and Referral to Treatment (SBIRT) provides an evidence-based (EB) framework to detect and treat SU. Evidence shows that mental health (MH) providers are not providing EB SU management. Federally grant-funded SBIRT demonstrated evidence of decreased SU and prevention of full disorders. Implementation outcomes in smaller-scale projects have included increased clinician knowledge, documentation and interdisciplinary teamwork.

Objective: To improve quality of care (QOC) for adolescents who use substances in the inpatient psychiatric setting by implementing EB SBIRT practices.

Methods: Research questions focused on whether the number of SBIRT notes documented (N=170 charts) increased and whether training of the interdisciplinary team (N=26 clinicians) increased SBIRT knowledge. Individualized interventions used existing processes, training and a new SBIRT Note template. An SBIRT knowledge survey was adapted from a similar study. A pre-and post-chart audit was conducted to show increase in SBIRT documentation. The rationale for the latter was not only for compliance, but also so that all team members can know the status of SBIRT services. Thus, increased interdisciplinary teamwork was an intentional, though indirect, outcome.

Results: A paired-samples t-test indicated clinician SBIRT knowledge significantly increased, with a large effect size. The results suggest that a short, 45-60-minute tailored education module can significantly increase clinician SBIRT knowledge. Auditing screening & BI notes both before and after the study period yielded important patient SU information and which types of SBIRT documentation increased post-implementation. The CRAFFT scores of the patients were quite high from a SU perspective, averaging over 3/6 both pre- and post-implementation, revealing over an 80% chance that the adolescent patient had a SU disorder. Most patients were positive for at least one substance (pre- = 47.1%; post- = 65.2%), with cannabis and alcohol being the most commonly used substances. Completed CRAFFT screenings increased from 62.5% to 72.7% of audited patients. Post-implementation, there were two types of BI notes: the preexisting Progress Note BI (PN BI) and the new Auto-Text BI (AT BI), part of the new SBIRT Note template introduced during implementation. The PN BIs not completed despite a positive screen increased from 79.6% to 83.7%. PN BIs increased 1%. The option for AT BI notes ameliorated this effect. Total BI notes completed for a patient positive for a substance increased from 20.4% to 32.6%, with 67.4% not receiving a documented BI. Total BIs completed for all patients was 21.2% post-implementation.

Conclusion: This project is scalable throughout the U.S. in MH settings and will provide crucial knowledge about positive and negative drivers in small-scale SBIRT implementations. The role of registered nurses (RNs), social workers and psychiatrists in providing SBIRT services as an interdisciplinary team will be enhanced. Likely conclusions are that short trainings can significantly increase clinician knowledge about SBIRT and compliance with standards. Consistent with prior evidence, significant management involvement, SBIRT champions, thought leaders and other consistent emphasis is necessary to continue improving SBIRT practice in the target setting.

Keywords: adolescents, teenagers, youth, alcohol, behavioral health, cannabis, crisis, documentation, drug use, epidemic, high-risk use, illicit drugs, implementation, mental health, opiates, opioid, pilot study, psychiatric inpatient hospital, quality improvement, SBIRT, Screening, Brief Intervention and Referral to Treatment, substance use, unhealthy alcohol use, use disorders

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  • 2019-05-02