Implementation Barriers to and Facilitators of Screening, Brief Intervention, Referral, and Treatment (SBIRT) in Federally Qualified Health Centers (FQHCs). Intervention Characteristics


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School-based health centers and other PCPs who treat adolescents are more likely to adopt SBI if the clinician perceives the intervention as: (a) having a strong theoretical foundation and clear conceptual basis for interpreting normative and non-normative patterns of adolescent development; (b) including strong research backing; (c) providing accurate knowledge regarding development, maintenance, and consequences of problem behaviors as well as developing adolescent skills and competencies that can replace targeted behaviors and protect students from their onset; (d) combining psycho-education and skill building; (e) optimizing timing, duration, frequency, and intensity of interventions, with early exposure prior to the onset of the target problem; (f) fitting into the education goals of schools or practice goals of health care providers; (g) maintaining fidelity through manualization and ongoing monitoring; (h) standardizing intervention delivery techniques for the staff; (i) involving teachers or primary care clinicians in adapting SBI to their unique environments; (j) designing materials and program components to engage youth; (k) using non-school personnel to facilitate acceptance and fit; and (l) ensuring that interventions are age-appropriate and developmental-stage-appropriate (i.e., abstinence for younger adolescents, binge drinking hazard reduction for older adolescents, and exclusively alcohol use for late adolescents and young adults).319, 320, 321

In school-based health centers319 and in rural322 and urban primary care practices,308 computer-assisted screeners and video game-style programs tailored to students' demographics and language preferences have successfully been used to engage students in SBI interventions and led to higher identification rates compared with self-report pen-and-paper tools. Interventions that alerted adolescents that their PCP check-up would include a discussion of substance use, and that prompted PCPs to bring up substance use with youth, facilitated better communication.323

Lack of adequate screening tools has also been identified as a barrier, although the CRAFFT tool is gaining acceptance generally. Other validated brief screening tools are available for use in primary care including the Global Appraisal of Individual Needed-Short Screener and the Adolescent Drinking Index. Electronic or computerized screening and integrating screening into EHRs may facilitate wider use of these tools and lessen workflow disruptions and the need for practice change in primary care settings including FQHCs.322, 324, 325 Lengthy screening questionnaires, whether written or online, will not be used.308, 326

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