The CEO of Phoenix House Foundation sees numerous factors converging to make high schools an ideal setting for screening and brief intervention efforts targeting young people. With marijuana policy changes and the persistent opioid crisis threatening to fuel increases in adolescent substance use, the time could be ripe for widespread screening that now can be reimbursed through healthcare as opposed to school system funding.
“Prevention has been a difficult area; it has not been particularly well-funded,” says Phoenix House CEO Howard Meitiner. “Also, there has not been a universally accepted evidence-based practice.”
Phoenix House was so keenly interested in coming up with a better formula than its traditional primary prevention activity in schools that it committed $250,000 to a pilot program driven by the request of an urban New York school district administrator. Promising results from that effort were published in the Journal of Substance Abuse Treatment, and now a much broader initiative will be launched next fall thanks to a three-year, $3 million grant from the Conrad N. Hilton Foundation.
Phoenix House’s partner in the new initiative is the Philadelphia-based Treatment Research Institute (TRI). Health communications research scientist Brenda L. Curtis, PhD, explains that in designing the screening protocol to be used, it was important to consider what approach would best engage young people (the pilot effort screened a group of middle and high school students, while the Hilton Foundation-funded program will focus on high schoolers only).
The result was a computerized screening program based on the look and feel of a computer game. But it still had to be presented with credibility, and not in a fashion that would turn off the adolescent to an unlikable character presenting the questions.
“We used voice animation; the character was face- and ethnicity-neutral, but gender-specific,” says Curtis.
The pilot, in which 248 students were screened, used the New York state-preferred CRAFFT adolescent screening tool and other measures to establish a risk profile for each individual. Students also were able to receive information about subjects such as substances’ effects on the brain and how to help a friend who might be overdosing.
Brief interventions from Phoenix House counselors not directly linked to the school system were then offered, with the intensity of the sessions based on each student’s risk profile. For those students not using substances much or at all, the intervention amounts to a reinforcing “atta boy,” says A. Thomas McLellan, PhD, TRI’s director. At the other end of the spectrum, the highest-risk students will see parental involvement in the situation so that joint decision-making about next steps can take place.
The pilot effort found that 42% of the students who were screened reported past-year use of alcohol or another drug. That percentage rests in sharp contrast to results of a state-required paper-and-pencil survey of students, which showed a 28% self-report rate for past-year substance use.
TRI researchers see the participation of non-school personnel and the use of the youth-friendly computer program as significant to the general level of acceptance they found. Almost no parents withheld the consent necessary for their children’s participation, although a much more substantial number failed to return insurance information that was required to receive healthcare reimbursement for the screening and brief intervention services.
“There are no new monies needed for this in New York state,” McLellan says. “This is an approvable service under Medicaid and most insurance.”
Curtis says the foundation-funded initiative likely will take place at four high schools in Suffolk County on Long Island. All students will be offered the screening, but participation will be voluntary.
Attacking the issue early
What compelled one of the largest treatment organizations in the country to invest substantial time and dollars in a prevention effort based in a location where screening and brief intervention has not been greatly tested to this point? Meitiner says much of the impetus came from seeing too many young people arrive for treatment with their lives already torn asunder.
“We were shoveling up the consequences of a lack of attention to this issue,” he says. He adds, “[Screening, Brief Intervention and Referral to Treatment] was being done in schools, but we were only seeing students that have a medical issue. What if we screened all the kids?”