The Case for Screening Students for Addiction, Mental Health Issues

Lilo H. Stainton | October 2, 2019 | Health Care
A school-based program of early intervention has worked in other states. Health advocates and others argue for its widespread adoption in New Jersey
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Brief screening and intervention has “potential to prevent years of addiction.”

To tamp down the epidemic of behavioral problems among young people, New Jersey should ensure schools systematically screen all students for mental health and drug use issues. That’s the recommendation of a group of lawmakers, health advocates and educators in a report released Tuesday, which also urged intervention before these problems emerge publicly or escalate, and connecting those who need more help with appropriate treatment.

These specific school-based programs are part of a proven clinical model and are effective and efficient in preventing suicide, substance use disorders and other chronic health problems later in life. This approach — which is growing nationwide — can also improve school attendance and performance, as well as future employment, they said.

In New Jersey, the model — known as SBIRT, for Screening Brief Intervention, and Referral to Treatment — has been used since 2012 at a half-dozen health care systems, and leaders said it works to reduce drug and alcohol use. The process uses standardized questions to create a score that can be used to determine an individual’s vulnerability to drug use or mental health issues; those with a certain score are identified for further assistance and possibly referred to outside treatment.

“A simple five to ten-minute screening and intervention has the potential to prevent years of addiction, saving not only the individual and family extensive pain but the fiscal cost to the larger community,” Lee Ruszczyk, the director of behavioral health at Henry J. Austin, a clinic in Trenton that is among those using SBIRT, said in “Youth at Risk,” the report, which was published by New Jersey Citizen Action.

Garden State schools are required to provide some form of screening and intervention services, but only a handful have adopted the SBIRT plan, advocates said, including facilities in Bordentown in Burlington County,  and Morris County. By requiring this model in schools statewide, all children would be assured a screening at some point and the process would become de-stigmatized if integrated into an annual preventive care routine, the group said.

Changing how the education system responds

“This program is proven to identify students who may be at risk for addiction in a way that is both confidential and compassionate,” said Sen. Joseph Vitale (D-Middlesex), who has championed a bill to expand it to all high schools. “SBIRT is a key tool in preventing drug and alcohol abuse, and could help us save generations of kids from addiction.”

Vitale and his allies also hope that greater use of the model in schools here would also change how the education system responds to students struggling with behavioral health issues. Instead of punishing young people for mental health issues or substance use — which may appear as bad behavior — the advocates said school systems should be better equipped to address these issues as clinical diseases.

“For far too long we’ve been focused on things like ‘zero tolerance’” models, which can lead students to be expelled or suspended, said Maura Collinsgru, the health program director for New Jersey Citizen Action. Zero tolerance has been particularly harmful to students of color, research shows, and has not been found to be particularly effective, the report notes.

Programs like SBIRT are “a public health response to a public health problem,” Collinsgru said. They can also help flag students who might be particularly vulnerable to mental health problems or substance abuse, not just those who already have a problem.  “It’s a preventative program that will help both save lives and improve academic outcomes,” she said.

The need is urgent, the group agreed. Suicide is now the third leading cause of death for New Jerseyans between ages 12 and 20, according to the report, and, nationwide, it has increased by more than 50 percent among this age group over the last decade. Those who identify as lesbian, gay, bisexual or transgender are five times more likely to kill themselves as their heterosexual peers.

Substance use is a primary cause of absenteeism

In addition, federal data shows that in 2015, a quarter of a million Americans aged 12 to 17 years reported using pain medication for “non-medical” purposes. Substance use is a primary reason for school absenteeism, experts note, and those not in school are more likely to have drug or alcohol problems. Research also shows that nine out of 10 adults with a substance use disorder began using drugs before their 18th birthday.

The SBIRT model was developed within the health care system years ago, but is not used in all practices. Recently, it has been implemented in some schools and universities, according to the report from the White House task force on opioid addiction, which was chaired by former New Jersey Gov. Chris Christie. “School nurses and counselors are uniquely positioned to discuss substance use among young people,” the task force wrote in August 2017.

The White House panel urged the federal government to spend $47 million to help states expand SBIRT programs, and the U.S. Department of Education to work with local educators to deploy programs in middle schools, high schools and on college campuses. Christie also pledged to expand SBIRT in New Jersey in the months before he left office, although it’s not clear what changes were implemented by his administration or that of Gov. Phil Murphy, who cancelled a number of Christie addiction initiatives when he took office in January 2018.

Nationwide, more than a dozen states have incorporated SBIRT programs in some of their schools, including New York, Maryland and North Carolina. In 2016, Massachusetts implemented a statewide approach in all middle and high schools and invested $2.4 million in the program over two years.

Annual screenings for all high schoolers?

The legislation to expand SBIRT in New Jersey schools, (S-491) first introduced in early 2017, has received limited attention to date. The bill would require schools — public, including charter schools, and private — to provide annual written screenings to all high school students. Those identified as a concern would get a brief counseling session; if additional services were deemed warranted, an outside referral would be provided.

Under the bill, parents would be given advance notice of the screenings and could have their child opt out; any information discussed would be kept private. School districts could select who should administer the test — a nurse, counselor or other professional — and the state Department of Human Services would help coordinate training for these individuals.

While the legislation does not include funding, advocates would like to see the state set up a training fund to ensure that school districts did not incur additional expenses. They also want to make sure Medicaid could be used to cover aspects of these programs; other states have tapped this and federal education dollars to help fuel SBIRT initiatives. According to some studies, every dollar invested in prevention saves $4 in treatment costs and up to $7 in law enforcement and criminal justice expenses.

“We have to work on prevention and intervention to protect our students as youth suicide rates increase and the opioid crisis rages on,” said Assemblywoman Carol Murphy (D-Monmouth), another sponsor of the bill. “Students spend most of their days at school, it is crucial that teachers are able to recognize the signs of abuse and mental health issues early on. Using SBIRT will give our teachers all the tools they need to look out for New Jersey’s children.”