Implementing SBIRT for adolescents within community mental health organizations: A mixed methods study

Objective: Many adolescents with substance use problems remain untreated, leading to increased risk for the development of substance use disorders. One response is Screening, Brief Intervention, and Referral to Treatment (SBIRT)—an evidence-based, early intervention that can be tailored for adolescents. This mixed methods study examined the implementation of SBIRT across 27 community mental health organizations (CMHOs) serving adolescents. Methods: Organizations completed surveys on the adoption of SBIRT and implementation barriers during the study period. Quantitative data were analyzed to examine the frequency of screening, brief intervention, and referrals. Qualitative data were coded using an iterative process that focused on barriers categorized according to the Conceptual Framework for Implementation Research (CFIR) constructs. Results: A total of 2873 adolescents were screened for alcohol and drug use with 1517 (52.8%) receiving a positive drug or alcohol screen. Positive screens that received brief intervention (BI)/referral to treatment (RT) had a significantly greater mean drug score and overall scores at baseline. The most salient implementation barriers were adaptability and complexity of SBIRT, policies related to funding and licensing, staff turnover, and implementation climate. Discussion: Nearly half of the adolescents scored positive for problematic substance use demonstrating the unmet need among this population. Future implementation efforts should focus on coordinating program demands, securing funding, integrating SBIRT into clinical workflows, retaining staff, and improving referral to treatment processes.