The use of SBIRT in Adolescent Population

The use of SBIRT in Adolescent Population
Quality Improvement Proposal

The use of SBIRT in Adolescent Population

Identify a quality improvement opportunity in your organization or practice. In a 1,250-1,500 word paper, describe the problem or issue and propose a quality improvement initiative based on evidence-based practice. Apply “The Road to Evidence-Based Practice” process, illustrated in Chapter 4 of your textbook, to create your proposal.

The use of SBIRT in Adolescent Population

Include the following:

  1. Provide an overview of the problem and the setting in which the problem or issue occurs.
  2. Explain why a quality improvement initiative is needed in this area and the expected outcome.
  3. Discuss how the results of previous research demonstrate support for the quality improvement initiative and its projected outcomes. Include a minimum of three peer-reviewed sources published within the last 5 years, not included in the course materials or textbook, that establish evidence in support of the quality improvement proposed.
  4. Discuss steps necessary to implement the quality improvement initiative. Provide evidence and rationale to support your answer.
  5. Explain how the quality improvement initiative will be evaluated to determine whether there was improvement.
  6. Support your explanation by identifying the variables, hypothesis test, and statistical test that you would need to prove that the quality improvement initiative succeeded.

The use of SBIRT in Adolescent Population


The use of SBIRT in Adolescent Population

Problem Overview

            Abusing drugs among adolescents is primarily prevalent in the United States. This makes adolescent years a critical window for the development of substance use disorders. Abusing drugs among the youth influence both their social and psychological development primarily cognitive development (Aldridge, Linford, & Bray, 2017). Nurses and physicians need to intervene early before substance abuse leads to cognitive health issues.  According to Johnston, O’Malley, Bachman & Schulenberg, 2013), physicians need to provide both holistic and quality care to their patients. Through the Road to Evidence-based practice, health care practitioners can find the evidence, appraise the evidence, implement the evidence and evaluate the evidence. Through the use of SBIRT as an evidence-based practice, healthcare practitioners can recognize, decrease and prevent harmful and unhealthy ways of substance use and abuse (Aldridge, Linford, & Bray, 2017). This paper develops a proposal for quality improvement through the introduction of screening, Referral to Treatment (SBIRT) screening tools, intervention, and intervention procedures to adolescent population affected by substance abuse in a health care institution.

Why a Quality Improvement Initiative is Required

The quality improvement initiatives are required because the use and abuse of drugs have become common among adolescents, which make it a critical public concern. The Healthy People 2020 developed critical objectives aimed to reduce substance use and abuse among teenagers (Healthy People 2020, 2018). In addition, most government agencies, medical institutions and medical professional associations have developed free counseling programs and screenings for youth such as initiatives that involve SBIRT integration within the medical health care system in collaboration with the White House Office of National Drug Control Policy, Agency for Health care Research and Quality, Health Resources and Services Administration, National Institutes of Health (NIH), and SAMHSA (Johnston, O’Malley, Bachman & Schulenberg, 2013). Besides, the medical professional associations and international and national public health agencies developed recommendations aimed to guide health care professionals to carry out screening and interventions for individuals especially teenagers believed to abuse and use drugs. Therefore, SBIRT is a critical part that can be placed as part of the Affordable Care Act legislation and Patient Protection Act to help deal with the issue of substance abuse among teenagers in the US (Johnston, O’Malley, Bachman & Schulenberg, 2013). Besides, based on the Periodic Screening, Diagnosis, and Treatment statue, each federal government in the US is expected to provide Medicaid screening assessments for both physical and mental development among teenagers.

Results from Previous Research

According to National Institute on Drug Abuse (2014), drugs such as alcohol, tobacco and other illegally prescribed drugs during adolescent are often abused during the adolescent stage. It is estimated that about 70% of students in high school have abused either alcohol or other drugs while 30% might have abused prescribed medications for non-medical reasons (NIDA, 2014). The desire to fit in and faces new experiences, and deal with peer pressure or problems in school are the primary reasons for abusing drugs.

According to Singh et al., (2017) the factors that influence the use of drugs among adolescent youths include peer pressure and the availability of narcotics in the school, community or neighborhood. The family environment is also a critical factor that may influence teenagers to use and abuse drugs. For example, a violent environment, mental illness, physical and emotional abuse, and the use of drugs in the household may influence the child to use and abuse drugs (Singh et al., (2017). Other factors for abuse of drugs includes the beliefs that drugs are cold, mental health conditions such as ADHD, anxiety, and depression, personality traits such as the need for excitement or poor impulse control, and adolescent’s inherited genetic vulnerability.

The U.S. Preventive Services Task Force (USPSTF) recommends providing routine screening for substance abuse among teenagers between 16 years and 17 years. The USPSTF also found that the use of SBIRT among teenagers is a critical area within the nursing practice that needs to be looked into. According to Aldridge, Linford, & Bray, (2017), SBIRT is a public health approach that is integrated and comprehensive to the delivery of treatment and intervention for individuals at risk of developing substance abuse disorder or for individuals who have a substance abuse disorder. The practice of SBIRT as an evidence-based practice involves screening individual’s suspected of substance abuse and encouraging them to change their behavior through motivational interviews and putting them under a treatment plan. Thus, SBIRT is a simple medical practice that is both effective and brief. Evidence from researches shows that cost-effectiveness and efficacy of SBIRT among adults and its help in managing drug use although is useful, it has mixed reaction. A study by Aldridge, Linford, & Bray, (2017), further states that SBIRT is the evidence-based practice that can help the use of drugs among the youths and prevent cannabis use among teenagers.

The use of SBIRT in Adolescent Population

SBIRT, as an intervention, also leads to changes in substance use behaviors among patients who were addicted to drugs and went through the SBIRT tool intervention plan. The large-cohort SAMHSA study in 2017, showed the effectiveness of the SBIRT intervention. The study was quasi-experimental and sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA, 2017). The study sample was about one million individuals, and the study participants were screened for substance abuse disorders, and the SBIRT was used as an intervention plan for five years. The use of SBIRT intervention process was linked with a decrease in substance use among the individuals who were under the SBIRT intervention process (SAMHSA, 2017). SBIRT is a critical intervention tool that is validated to help assess the risk of substance abuse and developing intervention to encourage the reduction of substance use and ensure treatment who have improve both physical and psychological issues resulting from substance use and misuse (Schmidt, 2010). Therefore, SBIRT is a standardized and evaluated screening tool that is effective, patient-centered, evidence-based and an ongoing transition to treatment and care of patients addicted to substance use.

Steps to Implement the Quality Improvement Initiative

            The first step of implementation of SBIRT intervention plan for patients engaged in substance abuse is to train the health care providers and physicians who will participate in the program. The health care providers who will be involved in the study will be reimbursed for every screening (SAMHSA, 2017). The SBIRT will include four steps during the screening process.

  1. The first step: The first step will involve the screening process where the health care practitioners will develop an evidence questionnaire to identify patient admitted for substance abuse ranging from addiction, problematic and riskiness of substance abuse. The screening process is critical in raising awareness to help people reduce substance use and misuse. The risk of substance use can be divided into four patterns: low risk or abstinence involves those who no consumption of alcohol, tobacco or any other drug. Driving risk includes those adolescents who use drug and alcohol and drive or ride with adolescents high on drugs or alcohol. Moderate risk includes individuals who have started using drugs and alcohol. Finally, high risk involves individuals who use drugs and alcohol often.
  2. The second step: This step involves a brief intervention process where teenagers showing mild symptoms get about 15 to 45-minute intervention including motivational interviewing. This helps to develop a behavioral change among teenagers to help reduce substance use and abuse.
  • The third step: The step involves a brief treatment process where adolescents with a score of moderate to severe in substance use and abuse are provided with a treatment plan that requires counseling sessions.
  1. The fourth step: The step involves the referral to treatment where the patients are connected to a physician for behavioral health treatment, comparative health assessment, or a specialty treatment program for substance abuse disorder.

The use of SBIRT in Adolescent Population

These steps are critical during the implementation of the SBIRT as an intervention plan based on the following essential components: identifying adolescent at risk of substance abuse and disorders, educate adolescents and create awareness on substance abuse by showing the dangers of drinking and using drugs to help adopt a more healthy behavior (Schmidt, 2010). The potential for preventing substance abuse in the United States should not be underestimated. SBIRT is a critical intervention tool that helps in the reduction of substance abuse and its implementation as evidenced-based practices is an economic strategy that can help reduce abuse among teenagers in the US.

The use of SBIRT in Adolescent Population


Aldridge, A., Linford, R., & Bray, J. (2017). Substance use outcomes of patients served by a broad US implementation of Screening, Brief Intervention and Referral to Treatment (SBIRT). Addiction, 112, 43–53.

Healthy People 2020. (2018). Increase the proportion of adolescents aged 12 to 17 years perceiving great risk associated with substance abuse. Retrieved from

Johnston, L., O’Malley, P., Bachman, J., & Schulenberg, J. (2013). Monitoring the Future National Results on Adolescent Drug Use: Overview of Key Findings. Bethesda, MD: National Institute on Drug Abuse, 2013. Retrieved from

National Institute on Drug Abuse [NIDA]. (2014). Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide. Retrieved from

Schmidt, C. S., Schulte, B., Seo, H.-N., Kuhn, S., O’Donnell, A., Kriston, L., … Reimer, J. (2010.). A meta-analysis on the effectiveness of alcohol screening with brief interventions for patients in emergency care settings. ADDICTION, 111(5), 783–794.

Singh, M., Gmyrek, A., Hernandez, A., Damon, D., & Hayashi, S. (2017). Sustaining Screening, Brief Intervention, and Referral to Treatment (SBIRT) services in health-care settings. Addiction, 112, 92–100.

Substance Abuse and Mental Health Services Administration [SAMHSA]. (2017). About screening, brief intervention, and referral to treatment (SBIRT). Retrieved from



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