School SBIRT
Pre-Training Assignment
Thank you for your interest in School SBIRT! This pre-training assignment is a
requirement of training and is intended to provide you with enough general
background so we can focus training on building the requisite skills and have time to
practice. It should take approximately one hour to complete. Please keep in mind that
this is an implementation training, that is, you and your district leadership have made
the decision to adopt SBIRT into practice and now the goal is to work toward
systematic implementation with fidelity.
Instructions:
1. Read the packet.
2. Print out and complete the quiz (last page).
3. Bring your completed quiz to training.
Completing this reading packet and the written quiz that follows is a requirement to
participate in the upcoming School SBIRT training.
What is SBIRT?
SBIRT stands for Screening, Brief Intervention, and Referral to Treatment. It is a well-established,
evidence-based, comprehensive public health model used to address selected health behaviors,
such alcohol/other drug (AOD) use within a population.1 SBIRT was originally designed for delivery
in busy healthcare settings to identify patients’ risky or problem AOD consumption and provide
early intervention. SBIRT is readily adapted for delivery in middle and high school settings by
members of the multidisciplinary team of pupil services (social worker, psychologist, counselor,
nurse) or other key school staff. Although the research to date is limited, initial studies show that
implementing SBIRT in the school setting is feasible and effective.2
Why Implement SBIRT?
1. Expands capacity of pupil services staff to address a range of behavioral health issues that
students can present. SBIRT is an evidenced-based practice for addressing adolescent
alcohol/other drug (AOD) involvement. Many studies have shown that when Brief Intervention
(BI) and Motivational Interviewing (MI) are delivered with fidelity to youth in general clinical
settings 3 or in school settings 4 the following results can be expected:
a. Reduced AOD use frequency.
b. Reduced AOD problem symptoms.
c. Increased rates of abstinence.
d. Effectiveness with diverse youth.
e. High rates of youth engagement and completion of services.
f. High rates of satisfaction.
SBIRT is also emerging as a promising practice to address a range of other student behavioral
concerns. 5 Several districts have applied SBIRT to address student mental health, attendance,
classroom behavioral referrals, fighting, and even homework completion.
2. SBIRT fits with pupil services values and philosophy. This model takes a student-centered and
strength-based approach to behavior change conversations. It is highly efficient and researchbased.
3. Student friendly. Evidence shows that students rate SBIRT services with high levels of
satisfaction. Services meet students where they are at with behavior change. There is no need
for problem recognition or for the student to “admit” to a problem for them to benefit from
1
Babor et al. (2007), SAMHSA (2011).
Curtis et al. (2014), Mitchell et al. (2013), Winters et al. (2007).
3
Barnett et al. (2012), Jensen et al. (2011), Lundahl et al. (2010), Naar-King & Suarez (2011), Tripodi et al. (2010).
4
Kelly & Lapworth (2006), Swan et al. (2008), Winters et al. (2012, 2014).
5
Frey et al. (2011), Herman et al. (2014), Reinke et al. (2011), Strait et al. (2012).
2
2
SBIRT. SBIRT takes a non-judgmental and collaborative approach to which students tend to
respond very positively.
4. Fits within the PBIS (Positive Behavioral and Intervention Supports) and RtI (Response to
Intervention) frameworks. SBIRT would ideally be delivered as a Tier 1 practice to universally
screen all students within a particular grade level. However, this is not feasible for currently
existing pupil services staff because there is not enough time or resources for you to accomplish
this. Therefore, SBIRT is considered a Tier 2 practice (with group-based BI), or a Tier 3 practice.
Understanding a student response to BI will be critical for implementation success. In SBIRT, RtI
is ascertained by simply re-administering the screening instruments at about one month from
the initial screening. We will discuss this process further during training.
Limitations of School SBIRT
• Although the research is very positive to date, it is underdeveloped.
• Tested down to age 12, therefore, SBIRT is not appropriate for elementary school students.
• Not useful for students who have already initiated behavior change.
• The harm reduction approach (e.g., reducing AOD use) may be inconsistent with any existing
“zero tolerance” school policies.
• Delivering SBIRT takes time and focus for staff during initial implementation.
SBIRT Components
Screening:
Shortly after introducing yourself and engaging the student, you will administer, score, and interpret
two screening instruments: the Global Appraisal of Individual Need - Short Screen (GAIN-SS) and the
Time Line Follow Back (30-day) Calendar. This process will take about 5 minutes. In that brief
amount of time, you will be able to ascertain a student’s level of risk in several salient areas of
behavioral health. One question that staff often ask in training is: How reliable is student self-report
on screening, especially regarding AOD use? When screening is preceded by best practices such as
good engagement, discussion of confidentiality, and asking permission before administering,
research has shown that student self-report reliability can be very good. Anecdotally, we have heard
from pupil services staff that student self-report has not been a problem. In fact, staff often express
amazement about how honest student responses are on the screening instruments.
3
Screening instrument #1: the Global Appraisal of Individual Need - Short Screen (GAIN-SS)
After each of the following questions, please tell us the last time that you had the problem, if
ever, by answering, “In the past month” (3), “2-12 months ago” (2), “1 or more years ago” (1),
or “Never” (0).
•
•
•
Never
The following questions are about common psychological, behavioral, and personal problems.
These problems are considered significant when you have them for two or more weeks, when
they keep coming back, when they keep you from meeting your responsibilities, or when they
make you feel like you can’t go on.
1+ years ago
•
2 to 12 months ago
•
The GAIN-SS was developed specifically for adolescents presenting in non-clinical settings.
It is well-established and has strong psychometrics for validity and reliability. 6
The GAIN-SS is endorsed by the Wisconsin Department of Public Instruction and has a webbased application: http://wifamilyties.org/gainss/public/
This instrument quickly ascertains level of risk (No/Low, Moderate, or High) on four domains:
1. Internalizing symptoms (i.e., mental health)
2. Externalizing symptoms (i.e., behavior/conduct)
3. Alcohol/Drug symptoms
4. Crime/Violence symptoms
To administer, you will read the instructions verbatim to the student:
Past month
•
•
•
3
2
1
0
Each domain contains 5 items (a.- e.) and the scoring is by domain with a range of 0 to 5.
To score, count up the number of symptoms endorsed within each domain for the past month
(the “3”s) or for the past 2-12 months (the “2”s).
Any past month/past 2-12 months symptoms gets scored as one point with this interpretation:
o Score of 0  No/Low Risk
“Risk” means likelihood that a clinical-level
o Score of 1 or 2  Moderate Risk
problem is present within that domain.
o Score of 3 or more  High Risk
Example Alcohol/Drug domain:
3. When was the last time that…
a. you used alcohol or drugs weekly? ………………………………………………………………………………….
b. you spent a lot of time either getting alcohol or drugs, using alcohol or drugs, or
feeling the effects of alcohol or drugs? ………………………………………………………………………..…
c. you kept using alcohol or drugs even though it was causing social problems,
leading to fights, or getting you into trouble with other people? …………………………………….
d. your use of alcohol or drugs caused you to give up, reduce or have problems
at important activities at work, school, home, or social events? ………………………...............
e. you had withdrawal problems from alcohol or drugs like shaking hands, throwing up,
having trouble sitting still or sleeping, or that you used any alcohol or drugs to stop
being sick or avoid withdrawal problems? ………………………………………………………………………
3
2
1
0
3
2
1
0
3
2
1
0
3
2
1
0
3
2
1
0
What is the score/interpretation of the above example? Score = 2 (past month symptom + past 2-12 months
symptom) which means there is Moderate Risk that a clinically significant AOD problem exists.
6
Dennis, Chan, and Funk (2006).
4
Externalizing
2.When was the last time that you did the following things two or more times?
a. Lied or conned to get things you wanted or to avoid having to do something? …………
b. Had a hard time paying attention at school, work, or home? ……………………………
c. Had a hard time listening to instructions at school, work, or home? ……………………
d. Were a bully or threatened other people? ………………………………………………..
e. Started fights with other people? ………………………………………………………..
Alcohol/Drug
3.When was the last time that…
a. you used alcohol or drugs weekly? …………………………………………………...…
b. you spent a lot of time either getting alcohol or drugs, using alcohol or drugs, or
feeling the effects of alcohol or drugs? ……………………………………………….…
c. you kept using alcohol or drugs even though it was causing social problems,
leading to fights, or getting you into trouble with other people? ………………………..
d. your use of alcohol or drugs caused you to give up, reduce or have problems
at important activities at work, school, home, or social events? ………………………...
e. you had withdrawal problems from alcohol or drugs like shaking hands, throwing up,
having trouble sitting still or sleeping, or that you used any alcohol or drugs to stop being
sick or avoid withdrawal problems? ………………………………………………
Crime/Violence
4. When was the last time that you…
a. had a disagreement in which you pushed, grabbed, or shoved someone? ……………....
b. took something from a store without paying for it? …………………………………...
c. sold, distributed, or helped to make illegal drugs? ………………………………………
d. drove a vehicle while under the influence of alcohol or illegal drugs? ………………….
e. purposely damaged or destroyed property that did not belong to you? …………………
Never
Internalizing
1.When was the last time that you had significant problems…
a. with feeling very trapped, lonely, sad, blue, depressed, or hopeless about the future? …
b. with sleeping, such as bad dreams, sleeping restlessly, or falling asleep during the day?
c. with feeling very anxious, nervous, tense, fearful, scared, panicked, or like something bad
was going to happen? ………………………………………….................................
d. with becoming very distressed and upset when something reminded you of the past? …
e. with thinking about ending your life or committing suicide? ……………………….......
1+ years ago
After each of the following questions, please tell us the last time that you had the problem, if
ever, by answering, “In the past month” (3), “2-12 months ago” (2), “1 or more years ago”
(1), or “Never” (0).
2 to 12 months ago
The following questions are about common psychological, behavioral, and personal
problems. These problems are considered significant when you have them for two or more
weeks, when they keep coming back, when they keep you from meeting your
responsibilities, or when they make you feel like you can’t go on.
Past month
Here is the GAIN-SS completed by a hypothetical student.
Please score and interpret these results and note your response on the Quiz (Item 5).
3
2
1
0
3
3
2
2
1
1
0
0
3
3
3
2
2
2
1
1
1
0
0
0
3
3
3
3
3
2
2
2
2
2
1
1
1
1
1
0
0
0
0
0
3
2
1
0
3
2
1
0
3
2
1
0
3
2
1
0
3
2
1
0
3
3
3
3
3
2
2
2
2
2
1
1
1
1
1
0
0
0
0
0
5
Screening instrument #2: the Time Line Follow Back (30-day) Calendar
•
•
•
•
7
The TLFB Calendar is well-established method to assess the frequency of a specific target
behavior – in partiuclar, student AOD use 7 – during the past 30 days.
The TLFB Calendar is administered following the GAIN-SS.
Administration
o First, fill in the calendar dates with the current date in the last row.
o Then, anchor the 30-day mark with student: “What was going on for you on this day,
30 days ago?”
o Instructions to student: “Using the symbol(s) provided, mark the calendar for
anytime [target behavior] occurred since
[student’s 30-day anchor] .”
o Clarify whether you want the days or number of times that the behavior occurred.
Interpretation
o Count up number of days/times the behavior occurred and note at the bottom of the
page in the space provided.
o Conduct a functional analysis with the student: “Looking at the calendar, tell me
about what you see.” Identify any patterns.
NIAAA (National Institute on Alcohol Abuse and Alcoholism). (n.d.). Alcohol Timeline Followback.
6
SBIRT Components (cont.)
Brief Intervention:
When the results of screening shows either moderate risk or high risk, or if your clinical judgment is
that intervention is needed, the Brief Intervention (BI) is initiated. The BI will be delivered using a
protocol and Motivational Interviewing (MI) skills. Typically, screening results will show more than
one area of concern. However, the BI will focus on a single target behavior/condition. This focus for
BI will largely depend on your district’s Initial Implementation Plan. This plan needs to be submitted
prior to training and outlines the target behaviors that you will use SBIRT to address. Delivery of BI is
flexible in terms of the number and duration of sessions. Experience has shown that the typical BI
process involves approximately 3 sessions lasting 15 minutes each. Here are important concepts
that underlie BI:
•
•
•
•
•
•
•
•
A guiding style of communication* is used. The core skills of guiding include Asking and
Listening (called Reflective Listening).
Directing, advising, telling the student what to do, or providing information and education is
not a part of BI.
The student’s internal motivation is the key to behavior change in this model.
In conversations about a specific behavior change, student ambivalence* about change is
often present. Ambivalence is a barrier to change and the BI will be used to explore and
(hopefully) resolve it.
Student Change Talk* drives successful behavior change. Change Talk is any student
language about the target behavior that is in the direction of change. Change Talk is
predictive of behavior change.
The opposite of Change Talk is Sustain Talk* which is any student language about the target
behavior that is in the direction of no change or the status quo. Sustain Talk is predictive of
no change.
The purpose of BI is to draw out and selectively reinforce student Change Talk and this is
accomplished through a skillful guiding style of communication.
Resist the Righting Reflex*. The righting reflex is what every helper has a tendency to do,
which is to tell the person why and how to change, give advice, and problem solve. But this
is not BI.
*These concepts are elaborated upon by Miller and Rollnick, the authors of Motivational
Interviewing. An excerpt of Chapter 1 from their brand new book follows. Please take a few
minutes to read the chapter. It’s a quick read. Understanding these concepts is critical for effective
delivery of SBIRT.
Referral to Treatment:
We will discuss this component of SBIRT in training, but basically, if the student shows high risk on
the initial screening and does not respond to BI, the next step will be to consider a referral internally
for more school-based services or externally to a licensed provider for assessment.
7
This is a chapter excerpt from Guilford Publications.
Motivational Interviewing: Helping People Change, Third Edition, by William R. Miller and Stephen Rollnick.
Copyright © 2013. Purchase this book now: www.guilford.com/p/miller2
chapter 1
3
Th
e
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rd
A fool takes no pleasure in understanding,
but only in expressing personal opinion.
—P roverbs 18:2
Pr
e
Things do not change: We change.
—H enry DaviD THoreau
ss
Conversations about Change
C
op
yr
ig
ht
©
20
1
They happen naturally every day: conversations about change. We ask
things of each other and are keenly attuned to the aspects of natural lan­
guage that signal reluctance, willingness, and commitment. In fact, a pri­
mary function of language, besides conveying information, is to motivate,
to influence each other’s behavior. It can be as simple as asking someone to
pass the salt or as complex as negotiating an international treaty.
There are also particular conversations about change that occur as
consultations with a professional, where one person seeks to help another to
make changes. Counselors, social workers, clergy, psychologists, coaches,
probation officers, and teachers all regularly engage in such conversations.
A large proportion of health care is concerned with managing chronic con­
ditions for which people’s own behavior and lifestyle determine their future
health, quality of life, and longevity. Thus physicians, dentists, nurses,
dietitians, and health educators are also regularly engaged in conversations
about behavior and lifestyle change (Rollnick, Miller, & Butler, 2008).
Other professional conversations focus on change that is not so
directly about behavior, unless “behavior” is defined in so broad a manner
as to encompass all of human experience. Forgiveness, for example, is a
significant psychological issue with broad health implications (Worthing­
ton, 2003, 2005). The focus of forgiveness may be someone who has died,
and its impact more on internal mental and emotional health than on overt
3
8
4
wHat iS Motivational interviewing?
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behavior. Self-concept, decisions, chosen attitudes, grief, and acceptance
are all common clinical issues that can influence behavior, but are them­
selves more matters of internal resolution. In this edition we explicitly
include such change as a worthy potential focus of MI (Wagner & Inger­
soll, 2009).
MI involves attention to natural language about change, with implica­
tions for how to have more effective conversations about it, particularly in
contexts where one person is acting as a helping professional for another.
Our experience is that many such conversations occur in a rather dysfunc­
tional way, albeit with the best of intentions. MI is designed to find a con­
structive way through the challenges that often arise when a helper ven­
tures into someone else’s motivation for change. In particular, MI is about
arranging conversations so that people talk themselves into change, based
on their own values and interests. Attitudes are not only reflected in but are
actively shaped by speech.
G
A cOnTInUUM OF STyLES
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It is possible to think about helping conversations as lying along a con­
tinuum (see Box 1.1). At one end is a directing style, in which the helper
is providing information, instruction, and advice. A director is someone
who tells people what to do and how to proceed. The implicit communica­
tion in directing is “I know what you should do, and here’s how to do it.”
A directing style has complementary roles for the recipient of direction,
such as obeying, adhering, and complying. Common examples of directing
are a physician explaining how to take a medication properly, or a proba­
tion officer explaining the contingencies and consequences imposed by the
court.
At the opposite end of this continuum is a following style. Good listen­
ers take an interest in what the other person has to say, seek to understand,
and respectfully refrain (at least temporarily) from inserting their own
material. The implicit communication of a helper in a following style is “I
trust your own wisdom, will stay with you, and will let you work this out
in your own way.” Some complementary roles to a following style are tak­
ing the lead, going ahead, and exploring. There are times in most practices
when following is appropriate—simply to listen as a human companion,
Box 1.1. a Continuum of Communication Styles
Directing
Guiding
Following
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Conversations about Change
5
THE RIGHTInG REFLEx
r
for example, with a dying patient for whom everything necessary has been
done, or a client who enters a session with strong emotion.
In the middle is a guiding style. Imagine going to another country
and hiring a guide to help you. It is not the guide’s job to order you when
to arrive, where to go, and what to see or do. Neither does a good guide
simply follow you around wherever you happen to wander. A skillful guide
is a good listener and also offers expertise where needed. MI lives in this
middle ground between directing and following, incorporating aspects of
each. Helping a child to learn a new task involves guiding—not doing too
much or too little to help. Box 1.2 provides some verbs associated with
each of these three styles of communication, all of which occur naturally
in everyday life.
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We appreciate and admire those who choose to be helpers. Henri Nou­
wen (2005) observed that “anyone who willingly enters into the pain of
a stranger is truly a remarkable person,” and we agree (p. 16). A life of
3
Box 1.2. Some verbs associated with each Communication Style
Directing style
Guiding style
Following style
Administer
Authorize
Command
Conduct
Decide
Determine
Govern
Lead
Manage
Order
Prescribe
Preside
Rule
Steer
Run
Take charge
Take command
Tell
Accompany
Arouse
Assist
Awaken
Collaborate
Elicit
Encourage
Enlighten
Inspire
Kindle
Lay before
Look after
Motivate
Offer
Point
Show
Support
Take along
Allow
Attend
Be responsive
Be with
Comprehend
Go along with
Grasp
Have faith in
Listen
Observe
Permit
Shadow
Stay with
Stick to
Take in
Take interest in
Understand
Value
10
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wHat iS Motivational interviewing?
r
service to others is a profound gift. A variety of selfless motives can draw
people into helping professions: a desire to give back, to prevent and allevi­
ate suffering, to manifest the love of God, or to make a positive difference
in the lives of others and in the world.
Ironically, these very same motives can lead to the overuse of a direct­
ing style in an ineffective or even counterproductive way when the task
is helping people to change. Helpers want to help, to set things right, to
get people on the road to health and wellness. Seeing people head down a
wrong path stimulates a natural desire to get out in front of them and say,
“Stop! Go back! Don’t you see? There is a better way over there!,” and it is
done with the best of intentions, with one’s heart in the right place. We call
this the “righting reflex”—the desire to fix what seems wrong with people
and to set them promptly on a better course, relying in particular on direct­
ing. What could possibly be wrong with that?
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AMbIvALEncE
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Consider next that most people who need to make a change are ambivalent
about doing so. They see both reasons to change and reasons not to. They
want to change and they don’t want to, all at the same time. It is a normal
human experience. In fact, it is an ordinary part of the change process, a
step along the way (DiClemente, 2003; Engle & Arkowitz, 2005). If you’re
ambivalent, you’re one step closer to changing.
There are also some people who need to make a change (at least in the
opinion of others), but themselves see little or no reason to do so. Perhaps
they like things just the way they are, or maybe they’ve tried to change in
the past and given up. For them, developing ambivalence about change
would be a step forward! (We address this in Chapter 18.)
But far and away the most common place to get stuck on the road to
change is ambivalence. Most people who smoke, drink too much, or exer­
cise too little are well aware of the downside of their behavior. Most people
who have had a heart attack know full well that they ought to quit smok­
ing, exercise regularly, and eat more healthily. Most people with diabetes
can recite the dreadful consequences that can ensue from poorly controlled
blood glucose. On the positive side, most people can also describe the mer­
its of saving money, being physically active, recycling, eating lots of fruits
and vegetables, and being kind to others. Yet other motives conflict with
doing the right thing, even when you know
what it is. Ambivalence is simultaneously
wanting and not wanting something, or
the most common place
wanting both of two incompatible things. It
to get stuck on the road to
has been human nature since the dawn of
change is ambivalence.
time.
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Conversations about Change
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It is therefore normal when a person is ambivalent to hear two kinds of
talk mixed together. One type is change talk—the person’s own statements
that favor change. In our first edition (Miller & Rollnick, 1991) we called
these “self-motivational statements.” The opposite type is sustain talk—the
person’s own arguments for not changing, for sustaining the status quo.
If you simply listen to a person who is ambivalent, both change talk and
sustain talk occur naturally, often within the same sentence: “I need to do
something about my weight [change talk] but I’ve tried about everything
and it never lasts [sustain talk]. I mean, I know I need to lose weight for my
health [change talk] but I just love to eat [sustain talk].” “Yes, but . . . ” is
the cadence of ambivalence.
There is something peculiarly sticky about ambivalence, even though it
can also be an uncomfortable place to be. People can remain stuck there for
a long time, vacillating between two choices, two paths, or two relation­
ships. Take a step in one direction and the other starts looking better. The
closer you get to one alternative, the more its disadvantages become appar­
ent while nostalgia for the other beckons. A common pattern is to think
of a reason for changing, then think of a reason not to change, then stop
thinking about it. The path out of ambivalence is to choose a direction and
follow it, to keep moving in the chosen direction.
Now consider what happens when an ambivalent individual meets a
helper with the righting reflex. Arguments both for and against change
already reside within the ambivalent person. The helper’s natural reflex is
to take up the “good” side of the argument, explaining why change is
important and advising how to do it. Talking with an alcohol-dependent
person, a helper might say, “You have a serious drinking problem and you
need to quit.” The fantasized reply is “Oh, I see. I just didn’t realize how
serious it is. OK, that’s what I’m going to
do!”; the more likely response, however, is
arguments both for and
“No I don’t.” Similarly, the helper’s natural
against change already
righting reflex when counseling a pregnant
reside within the ambivalent
drinker is to educate her about the dangers of
person.
alcohol to the unborn child.
Chances are, however, that the person has already heard the “good”
arguments, not only from others but also from a voice within. Ambiva­
lence is a bit like having a committee inside your mind, with members who
disagree on the proper course of action. A helper who follows the righting
reflex and argues for change is siding with one voice on the person’s inter­
nal committee.
So what happens next? There is a rather predictable response when
a person who feels two ways about something hears one side of the pic­
ture being emphasized: “Yes, but . . . ” or maybe just “But . . . ” with­
out the “Yes.” (This also happens in committees where there is disagree­
ment.) Argue for one side and the ambivalent person is likely to take up
12
Conversations about Change
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and defend the opposite. This sometimes gets labeled as “denial” or “resis­
tance” or “being oppositional,” but there is nothing pathological about
such responses. It is the normal nature of ambivalence and debate.
This debate process might seem therapeutic—a kind of psychodra­
matic acting out of the person’s ambivalence with the helper simply repre­
senting the pro-change side—were it not for another principle of human
nature, which is that most people tend to believe themselves and trust their
own opinions more than those of others. Causing someone to verbalize one
side of an issue tends to move the person’s balance of opinion in that direc­
tion. In other words, people learn about their own attitudes and beliefs in
the same way that others learn them: by hearing themselves talk (Bem,
1967, 1972). From this perspective, if you as a helper are arguing for change
and your client is arguing against it, you’ve
got it exactly backward. Ideally, the client
if you are arguing for
should be voicing the reasons for change.
change and your client is
Any successful salesperson knows this. Peo­
arguing against it, you’ve
ple are quite sensitive to how they are spoken
got it exactly backward.
to about an ambivalent topic, in part because
3
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they have already been having these same discussions about change within
themselves. The righting reflex and associated directing style tends to set up
an oppositional pattern of conversation. How constructive is this, and
what’s the likely outcome?
13
Delivering the SBIRT protocol will involve this process:
1) Engaging
The first minutes of meeting with the student involves engaging which will include a brief
introduction of yourself, purpose of the meeting, and finding out the student’s perspective.
Your careful listening and reflection will be essential to successfully engage the student in
the conversation about behavior change. Initial engagement is accomplished the moment
the student feels you are a collaborative partner who is willing to suspend judgment to listen
and understand his/her perspectives. Once engagement has occurred, you will administer
the screening instruments.
2) Focusing
Focusing involves selecting the target behavior for the BI. The target behavior may already
be determined as part of your district’s implementation plan. Alternatively, the target
behavior may be decided based on the screening results and your clinical judgment. In either
case, once the target behavior is established, that will be the focus of the Brief Intervention.
3) Evoking
Once the target behavior (focus) of the BI is clear, evoking involves exploring the student’s
perspective on change and proactively drawing out the student’s reasons and ideas for
change (Change Talk). The protocol will guide you to ask key Open Questions and use
strategies to elicit student Change Talk, then you will listen carefully and strategically reflect
the Change Talk you hear. This process is the heart of BI. The opposite of evoking is
educating. Refrain from giving information, advising, or telling the student why he/she
should change – that is, resist the Righting Reflex!
4) Planning
This is the final process and completes the BI session. Planning begins with collaboratively
developing a change goal with the student. The goal should be specific to the target behavior
as well as measurable, and it will be the student’s choice. Once the goal is set, you will then
work with the student to develop a supporting plan for how the goal will be achieved. Again,
the protocol will guide this process. Like in earlier processes, you job is to listen carefully,
reflect, and resist the Righting Reflex.
Each process builds upon the next: Engaging is established at the beginning and is maintained
throughout; Focusing on the target behavior is maintained during Evoking;
Evoking student motivation for change sets the stage for effective Planning.
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A Flow Chart of Delivering SBIRT
(District/Building-level)
1
Identify your specific student population and target behavior(s), then
systematically screen all these students. Score and interpret screening.
Initial Screening = GAIN-SS + TLFB Calendar
Moderate Risk
No/Low Risk
2
High Risk
For students who show Moderate/High risk
results, initiate Brief Intervention (BI) regarding
the specific target behavior.
Initial BI Session
3
4
Provide follow up Brief Intervention
(up to 4 sessions).
Follow Up BI Sessions
Final BI session (~1 month from initial session): re-administer screening to
ascertain response to BI; consider Referral to Treatment (RT) including an internal
school-based referral or recommendation for community-based services.
Final BI Session, Follow Up Screening
RT
?
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References
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Babor, T. F., McRee, B. G., Kassebaun, P. A., Grimaldi, P. L., Ahmed, K., & Bray, J. (2007). Screening, Brief
Intervention, and Referral to Treatment (SBIRT): Toward a public health approach to the management of
substance abuse. Substance Abuse, 28(3), 7-30. Access from
http://www.dhs.wisconsin.gov/substabuse/SBIRT/2007SBIRToverview.pdf
Barnett, E., Sussman, S., Smith, C., Rohrbach, L. A., & Spruijt-Metz, D. (2012). Motivational interviewing
for adolescent substance use: A review of the literature. Addictive Behaviors, 37, 1325-1334.
Curtis, B. L., McLellan, A. T., & Gabellini, B. N. (2014). Translating SBIRT to public school settings: An
initial test of feasibility. Journal of Substance Abuse Treatment, 46(1), 15-21.
Dennis, M. L., Chan, Y., & Funk, R. R. (2006). Development and validation of the GAIN short screener
(GSS) for internalizing, externalizing and substance use disorders and crime/violence problems among
adolescents and adults. The American Journal on Addictions, 15, 80-91. Access from:
http://gaincc.org/_data/files/Instruments%20and%20Reports/GAINSS%20psych%20article.pdf
Frey, A. J., Cloud, R. N., Lee, J., Small, J. W., Seeley, J. R., Feil, E. G., Walker, H. M., & Golly, A. (2011). The
promise of motivational interviewing in school mental health. School Mental Health, 3, 1-12.
Herman, K. C., Reinke, W. M., Frey, A. J., & Shepard, S. A. (2014). Motivational interviewing in schools:
Engaging parents, teachers, and students. New York: Springer Publishing Company.
Jensen, C. D., Cushing, C. C., Aylward, B. S., Craig, J. T., Sorell, D. M., & Steele, R. G. (2011). Effectiveness
of motivational interviewing for adolescent substance use behavior change: A meta-analytic review.
Journal of Consulting and Clinical Psychology, 79(4), 433-440.
Kelly, A. B., & Lapworth, K. (2006). The HYP program: Targeted motivational interviewing for adolescent
violations of school tobacco policy. Preventive Medicine, 43, 466-471.
Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). New York:
Gilford Press.
Mitchell, S. G., Gryczynski, J., O’Grady, K. E., & Schwartz, R. P. (2013). SBIRT for adolescent drug and
alcohol use: Current status and future directions. Journal of Substance Abuse Treatment, 44, 463-472.
Naar-King, S. & Suarez, M. (Eds.), Motivational interviewing with adolescents and young adults. New
York: Guilford Press.
NIAAA (National Institute on Alcohol Abuse and Alcoholism). (n.d.). Alcohol Timeline Followback (TLFB).
Accessed from http://pubs.niaaa.nih.gov/publications/AssessingAlcohol/InstrumentPDFs/13_TLFB.pdf
Reinke, W. M., Herman, K. C., & Sprick, R. (2011). Motivational interviewing for effective classroom
management: The classroom check-up. New York: Guilford Press.
SAMHSA (Substance Abuse and Mental Health Services Administration). (2011). Screening, Brief
Intervention, and Referral to Treatment (SBIRT) in behavioral healthcare. Accessed from
http://www.samhsa.gov/prevention/sbirt/SBIRTwhitepaper.pdf
Swan, M., Schwartz, S., Berg, B., Walker, D., Stephens, R., & Roffman, R. (2008). The Teen Marijuana
Check-Up: An in-school protocol for eliciting voluntary self-assessment of marijuana use. Journal of Social
Work Practice in the Addictions, 8(3), 284-302.
Tripodi, S. J., Bender, K., Litschge, C., & Vaughn, M. G. (2010). Interventions for reducing adolescent
alcohol abuse: A meta-analytic review. Archives of Pediatric Medicine, 164(1), 85-91.
Winters, K. C., Fahnhorst, T., Botzet, A., Lee, S., & Lalone, B. (2012). Brief intervention for drug-abusing
adolescents in a school setting: Outcomes and mediating factors. Journal of Substance Abuse Treatment,
42, 279-288.
Winters, K. C., Lee, S., Botzet, A., Fahnhorst, T., & Nicholson, A. (2014). One-year outcomes and
mediators of a brief intervention for drug abusing adolescents. Psychology of Addictive Behaviors, 28(2),
464-474.
Winters, K. C., Leitten, W., Wagner, E., & O’Leary Tevyaw, T. (2007). Use of brief interventions for drugabusing teenagers within a middle and high school setting. Journal of School Health, 77, 196-206.
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School SBIRT Quiz
Please print out, complete, and bring this quiz to training. Completing this quiz is a requirement of training.
Your Name: ________________________________________________
District: ____________________________________
1.
What does SBIRT stand for? _________________________________________________________________________________
2.
Which of the following is a reason to deliver SBIRT?
a. Evidence-based practice to address student alcohol/drug use.
b. Fits within PBIS as a Tier 2 practice because the Brief Intervention can be delivered with a small group of students.
c. High levels of satisfaction reported by students.
d. Uses Response to Intervention to ascertain effectiveness.
e. All of the above.
3.
There are limitations to delivering SBIRT. Which is NOT a limitation?
a. The reliability of student self-report in the screening is questionable.
b. Students who have already initiated changes will not likely benefit.
c. Accepting student reduced use of alcohol/drug (harm reduction) may not fit with a district’s “zero tolerance” policy.
d. Implementing SBIRT requires initial time and focus by staff.
4.
Which of the following is a best practice for promoting student self-report reliability on the screening?
a. Discuss confidentiality of screening results with the student.
b. Inform the student that screening results will be kept a secret.
c. Prior to screening, first engage the student.
d. Ask permission to administer the screening.
e. Options a., c., and d.
5.
Fill in the blanks by noting the score and interpretation of each GAIN-SS domain from the example on page 5:
a. Internalizing domain score = ____
Level of risk: ____________________
b. Externalizing domain score = ____
Level of risk: ____________________
c. Alcohol/Drug domain score = ____
Level of risk: ____________________
d. Crime/Violence domain score = ____ Level of risk: ____________________
6.
Based on the results of the GAIN-SS example, what would be best rational for focus of Brief Intervention?
a. Crime/Violence because safety in schools is a top priority.
b. Anxiety (internalizing symptom) because that’s what the student wants to address.
c. Alcohol/Drug use because that domain showed the highest level of risk.
d. Alcohol/Drug use because that is on the district’s implementation plan to address.
7.
Which of the following is true about students who experience ambivalence about change?
a. Ambivalence is a common experience.
b. Ambivalence is a barrier to change.
c. Ambivalence is a mixture of Change Talk and Sustain Talk.
d. All of the above.
8.
True or False: Utilizing the righting reflex is an important part of how Brief Intervention works.
a. True
b. False
9.
What is the typical process of delivering SBIRT (in order)?
a. Focusing, Screening, Engaging, Evoking, Planning
b. Engaging, Screening, Focusing, Educating, Planning
c. Focusing, Screening, Engaging, Educating, Planning
d. Engaging, Screening, Focusing, Evoking, Planning
e. Screening, Focusing, Educating, Planning
10. Of the four processes, which one is the heart of Brief Intervention? ____________________________
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