SBIRT in Schools Toolkit – Final Rev 8-30-2021
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SBIRT IN SCHOOLS RESOURCE TOOLKIT
Verbal Substance Use Screening Program in Massachusetts Schools
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SBIRT in Schools Resource Toolkit
Table of Contents
Introduction .................................................................................................................................... 3
The Law ........................................................................................................................................... 4
Overview of Screening, Brief Intervention, and Referral to Treatment (SBIRT) ............................ 5
SBIRT in Schools Process ................................................................................................................. 5
Screening ................................................................................................................................. 5
Brief Intervention .................................................................................................................... 6
Referral to Treatment ............................................................................................................. 7
Consent to Disclose Confidential Information ........................................................................ 7
SBIRT Planning ................................................................................................................................ 7
Parent/Guardian Notification and Opt-out Procedure ................................................................. 11
SBIRT Team and Key Stakeholders ................................................................................................ 11
Data Collection and Reporting Requirements .............................................................................. 11
Providing Substance Use Education and Feedback ...................................................................... 12
Appendix A: MGL Chapter 71, Section 96 .................................................................................... 13
Appendix B: Introduction to Screening Script .............................................................................. 15
Appendix C: CRAFFT+N Tool Sample ............................................................................................ 16
Appendix D: REACT Worksheet .................................................................................................... 17
Appendix E: Brief Negotiated Interview Worksheet .................................................................... 18
Appendix F: Referral Types and Sample Scripts ........................................................................... 20
Appendix G: Referral Resources .................................................................................................. 22
Appendix H: Sample Consent to Disclose Confidential Information ........................................... 23
Appendix I: SBIRT Stakeholders and Team ................................................................................... 24
Appendix J: SBIRT Planning Checklist ............................................................................................ 26
Appendix K: Orange Card Sample ................................................................................................. 28
Appendix L: Sample Parent Letter ................................................................................................ 29
Appendix M: Educational Information on Nicotine, Alcohol, and Marijuana ............................. 30
Appendix N: Submitting SBIRT Data Using Online Data Collection Tool ..................................... 34
References .................................................................................................................................... 42
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Introduction
This toolkit is designed to assist Screening, Brief Intervention, and Referral to Treatment (SBIRT) teams in
planning their annual verbal substance use screening programs. It provides information about the law, the
SBIRT process, planning resources, reporting requirements, education resources, and links to helpful
websites. The appendices contain tools and samples school SBIRT teams can use when conducting SBIRT.
Be aware that SBIRT resources are continually being updated, so prior to conducting annual verbal
substance use screenings, SBIRT teams should check the SHIELD and MASBIRT TTA websites for any tools
and resources updates.
Note: Throughout this toolkit, reference is made to the SHIELD and MASBIRT TTA websites. These are
located at:
SHIELD – https://shield.bu.edu/
MASBIRT TTA – https://www.masbirt.org/schools
This toolkit also references several Massachusetts Department of Public Health services and resources
worth bookmarking:
• Bureau of Substance Addiction Services (BSAS) – BSAS oversees the statewide system of
prevention, intervention, treatment, and recovery support services for individuals, families,
and communities affected by gambling and substance addiction.
• BSAS Office of Youth and Young Adult Services (OYYAS) – BSAS funds youth & transitional age
youth programs to provide developmentally appropriate, strength-based, culturally
responsive, and trauma-informed services for those living with a substance use disorder (SUD).
• Department of Mental Health – The Department of Mental Health, as the State Mental Health
Authority, assures and provides access to services and supports to meet the mental health
needs of individuals of all ages; enabling them to live, work, and participate in their
communities.
• School Health Services – School Health Services is comprised of professional staff who
collaborate with other Department of Public Health programs and the MA Department of
Elementary and Secondary Education to provide ongoing school health service systems
development and technical assistance to the Commonwealth's public school districts and
nonpublic schools.
• Massachusetts Health Promotion Clearinghouse – Massachusetts Health Promotion
Clearinghouse provides free promotional materials including toolkits, informational
brochures, posters, and other helpful materials.
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The Law
Since the passage of the Act Relative to Substance Use, Treatment, Education, and Prevention (STEP Act)
in 2016, annual verbal substance use screening of adolescents in two grades has been required by law in
all public schools.
State and local leaders have made substance use prevention and education a priority. Beginning in the
2017-2018 school year, each city, town, regional school district, charter school, and vocational school
district in Massachusetts were required to implement verbal substance use screenings as set forth in
Massachusetts General Laws (MGL) Chapter 71, section 97.
Key requirements of the law include:
• Annually screen two grade levels (one middle school and one high school grade level).
• Use the approved screening tool selected by the Massachusetts Department of Public Health (DPH)
and Department of Elementary and Secondary Education (DESE). Currently, the CRAFFT+N
screening tool is the only one approved by DPH and DESE. The law does allow districts to select
another screening tool, but they must provide DPH with a detailed written description of the
alternative program including reasons why the required verbal screening tool is not appropriate
for their district.
• Parents/guardians must be notified about the screening prior to the start of the year and must be
given the option to opt out in writing.
• What a student discloses during the verbal screening will be kept as confidential as possible.
Exceptions to confidentiality include if the student’s parent or guardian requests the information,
in cases of immediate medical emergency, or when disclosure is otherwise required by state law.
A student, parent, or guardian may provide written consent to share information collected during
the verbal screening with other persons.
• When consent to release information is needed, it must be documented on a DPH-approved form.
• There can be no record (written, electronic, or otherwise) of verbal screening results that identifies
an individual student.
• All de-identified data is reported to DPH within 90 days of screening completion.
The full text of the MGL Ch 71, sec 97 and its amendments is provided in Appendix A.
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Overview of Screening, Brief Intervention, and Referral to Treatment
(SBIRT)
DPH and DESE have selected SBIRT utilizing the CRAFFT+N screening questionnaire as the approved
approach to conduct verbal substance use screenings in schools. Originally developed for use in primary
care settings, the evidence-based practice of SBIRT is now used across the fields of health and human
services as a population health approach to identifying and addressing unhealthy substance use and
supporting healthier choices.
SBIRT with adolescents focuses on prevention, early detection, risk assessment, brief counseling, and,
when needed, referral for further assessment or treatment. The SBIRT process begins by using a validated
screening tool (CRAFFT+N) to identify the student’s current substance use behaviors and related risks, and
moves into a one-on-one conversation using motivational interviewing techniques to support and
reinforce healthy behaviors and to explore knowledge of and motivation for changing unhealthy behaviors.
In some cases, SBIRT may identify a student with more frequent or dangerous substance use who requires
referral for further assessment or treatment.
As trusted healthcare providers in the school, school nurses and counseling staff are uniquely positioned
to discuss substance use among young people. The brevity, ease of use, and the predictive strength of
SBIRT will assist trained staff to promote healthy behaviors, identify substance use, and to provide brief
counseling and referral for support, as necessary, to prevent harm at the earliest stages among students.
The goal of doing SBIRT in schools is to empower students to make decisions that promote their health
and safety, and to provide an opportunity for early identification of risks related to alcohol, tobacco,
nicotine, and other drug use. Achieving this goal requires the collaboration of parents/guardians, local
health care providers, students, school health professionals (i.e., nurses, counselors, psychologists), and
other members of the school staff and administration.
SBIRT in Schools Process
The steps of the SBIRT process used in schools are described below.
Screening
SBIRT in Schools utilizes the CRAFFT+N behavioral health questionnaire. This verbal substance-use
screening tool is empirically-based and developed through primary research and is validated for use with
children ages twelve and older (Knight 2002; Levy, et al, 2004). Use of a validated screening tool will enable
school health professionals (i.e., nurses and counselors) to detect risk for alcohol, tobacco, nicotine, and
other drug use and related harms, and to address them at an early stage in adolescence. In the course of
the SBIRT process, other behavioral health concerns may be identified and appropriate school staff may
be alerted.
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Screening consists of two parts: first, the screening is introduced to the student using a DPH-approved
script, and, second, students are asked the questions listed on the CRAFFT+N questionnaire.
Read an Introduction:
Before beginning the actual screen, each student must be read an introduction. This introduction to the
screening questionnaire follows a scripted approach to ensure efficiency, accuracy, and consistency
throughout the state. Screening team members should have a copy of this script readily available when
they introduce the screening to students. A copy of this script is provided in Appendix B.
Utilize the CRAFFT+N:
Students are asked the questions exactly as written on the CRAFFT+N screening questionnaire. A sample
of the CRAFFT+N screening questionnaire is available in Appendix C. This tool may be updated from time-
to-time based on ongoing research. The most current version, as well as translated versions, of both the
introduction and CRAFFT+N can be found on the MASBIRT TTA website.
Brief Intervention
The brief intervention portion of SBIRT is a short, goal-oriented conversation that follows the screening.
Once the screening questionnaire is completed, there are two possible scenarios for the brief intervention:
REACT and the Brief Negotiated Interview (BNI).
REACT for Students who Screen Negative for Substance Use:
The first scenario is for students who do not report any substance use in the past twelve months. These
students have screened negative. They will receive positive reinforcement for making healthy decisions.
This is offered during a brief one-on-one conversation. The goal is to support the continuation of safe
choices around health, safety, and success in school, and plan for any future challenges.
This conversation is delivered using a three-step model called REACT, which is a structured guide that
stands for Reinforce, Educate, and Anticipate Challenges of Tomorrow (adapted from MASBIRT TTA
content). An example of REACT with sample scripts is available in Appendix D.
Brief Negotiated Interview (BNI) for Students who Screen Positive for Substance Use:
The second scenario is for students who report some substance use over the past twelve months. This may
include experimentation, infrequent use, or frequent use. These students have screened positive, and will
receive a brief intervention in the form of the BNI. This is offered during a one-on-one conversation that
uses motivational interviewing strategies. The BNI is delivered using a structured conversation that
explores behavior change in a respectful, non-judgmental manner. The BNI is intentionally designed to
elicit reasons for change and action steps from the student. An example of the BNI with scripts is found in
Appendix E.
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Referral to Treatment
Some students may need a follow-up conversation to increase awareness and further build motivation to
change risky behaviors related to substance use. Students may be referred to in-school health
professionals (i.e., adjustment counselors, school psychologists, or school nurses). If the screening and/or
subsequent assessment indicate that the student needs support beyond what the school can offer, an
external referral may be warranted. If the student indicates immediate threat of harm to themselves or
others, including a medical emergency, an outside referral or 911 call may be indicated. See Appendix F
for more information on referral types and sample scripts on how you might talk with the student about
that referral.
The BSAS Office of Youth and Young Adult Services (OYYAS) offers a continuum of services. The most
appropriate outpatient treatment service to refer SBIRT screened students is to Adolescent Community
Reinforcement Approach (A-CRA). A-CRA is brief, evidence-based treatment developed by Chestnut Health
Systems for youth and young adults ages 12-24. ACR-A teaches coping skills, is delivered in the community,
clinics, schools or homes, includes family sessions, and is delivered by A-CRA trained and certified clinicians.
In addition to A-CRA, other services offered through OYYAS include: detox and stabilization, residential,
recovery high schools (managed by DESE), and medication for substance use disorders. The office is also
expanding services to include school-based intervention. See Appendix G for referral resources.
Consent to Disclose Confidential Information
The Step Act and the amendment enacted in 2018 states that, “Any statement, response or disclosure
made by a pupil during a verbal substance use disorder screening shall be considered confidential
information and shall not be disclosed by a person receiving the statement, response or disclosure to any
other person without the prior written consent of the pupil, parent or guardian, except in cases of
immediate medical emergency or a disclosure is otherwise required by state law; provided, however, that
the screening required under this section shall be implemented in accordance with applicable state and
federal laws and regulations pertaining to student confidentiality.” Therefore, when considering a referral
beyond the screening wherein the screener will disclose information or student answers from the
screening to another person, a consent form must be signed. A sample consent form can be found in
Appendix H.
SBIRT Planning
Team Approach
There are many SBIRT team models in schools across the state; no “right” model exists, but what is
important to recognize is that a team approach is essential. The team includes not only school staff and
administrators, but parents, students, and members of the community. Appendix I details team members
and their roles. Regardless of the model or number of staff involved, training, along with strong
communication systems and procedures, should be in place to ensure students receive appropriate
support and services. Knowledgeable administrators ensure that team members have time for planning,
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access to students, and appropriate follow-up plans. Below is a detailed description of the steps needed
for conducting annual verbal substance use screenings using the SBIRT in Schools model. A checklist your
team can use to help ensure your screening program is successful each year is provided in Appendix J.
Step 1: Formative Planning
Formative planning includes the initial steps when preparing to conduct your verbal substance use
screenings using SBIRT in the school each year. It includes outlining the scope of work, timeline, systems
of communication, and SBIRT team members.
Objectives:
- Establish an SBIRT planning team and a SBIRT team lead or coordinator.
o This team will consist of screeners as well as all of the people you will need to prepare and
organize your SBIRT program. This might include administrators, nurses, guidance
counselors, adjustment counselors, social workers, and school psychologists. It can be
helpful to think broadly. Consider who might be interested in supporting and/or
participating in the SBIRT process in some way.
- Develop a system of communication.
o This will help you provide updates to the SBIRT team and the wider school community.
Consider an SBIRT planning team contact list or email listserv. Also consider how you will
share information and documents needed to implement SBIRT.
- Plan timeline for conducting SBIRT.
o Based on your school calendar, determine when key decisions need to be made, as well as
date(s) for conducting SBIRT, and debrief meeting in your school. Move backwards from
your projected screening dates to book any necessary meetings and communication
deadlines in advance.
- Conduct a review of current process and procedures.
o If you have conducted SBIRT in the past, look at the prior years’ plan and consider what
you might tweak for the upcoming year. If you are new to SBIRT, consider how to build
SBIRT into your existing processes for other school health screenings.
- Review relevant school policies and procedures regarding substance use.
o Conduct a review of relevant policies and procedures to identify any that may contradict
SBIRT approaches (e.g., zero tolerance). Consult policies from other districts for
recommendations on wording that support students and moves away from punitive
approaches for disclosure of substance use. Please see the OYYAS document Student
Substance Use: How School Can Respond which can be downloaded from the
Massachusetts Health Promotion Clearinghouse.
- Identify internal and external referral resources.
o It is important to begin the process of thinking about internal and external supports early
in the SBIRT planning process. Discuss criteria to match type and intensity of referral
services to student needs. Consider what current referral resources are being used and
whether they are sufficient.
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- Review data related to adolescent substance use.
o Annually review local, regional, statewide and national data to gather a complete picture
of prevalence, trends, and commonly used substances. Use this knowledge when engaging
community stakeholders, planning which grades to screen, and developing the
educational resources you will use during SBIRT.
Step 2: Process Planning
Process planning is the detailed consideration of all of the components of SBIRT, and supports the
development of procedures and strategies for executing every stage of your verbal substance use
screening program.
Objectives:
- Identify and contact key stakeholders outside of the SBIRT team.
o This may include other teachers, community coalitions, and/or healthcare providers,
including a community-based A-CRA provider. It is helpful to start communication with
these stakeholders early in the planning process, even if you still need to make decisions
on your procedures.
- Establish SBIRT procedures.
o Identify which grade(s) will go through SBIRT.
o Identify the time of year to conduct SBIRT and if you will conduct SBIRT at one time or on
a rolling basis.
o Identify how you will keep track of which students have been screened. This list needs to
be separate from any student responses to screening questions.
o Identify which personnel will be involved in directly conducting SBIRT. Most schools use a
team of school health professionals including school nurses, school guidance, and school
adjustment counselors. You might also consider other members of your school
community, as appropriate. Being thoughtful about who screens students is important.
The goal is to have screeners with whom students feel safe talking about substance use.
o Identify how you will pair students with those conducting SBIRT. Some schools decide to
let this be random, and others create lists ahead of time to match particular students with
suitable SBIRT staff. For example, some schools choose to pair students with serious co-
morbid health conditions with school nurses during SBIRT.
o Identify which personnel will be involved in referrals, and identify processes for referrals
or warm hand-offs.
o Identify the location to conduct SBIRT. Ensure that any location used includes
considerations of student privacy and confidentiality. Some schools use private offices for
each student, some use larger rooms with adequate visual separation and noise control.
o Establish a process for data collection using the MDPH Data Collection Tool. You might use
a computer or tablet for each screener to directly input data, or print out the Data
Collection Tool and manually write in appropriate data to compile electronically after
SBIRT is completed.
o Determine what educational materials or information will be shared with students.
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o Develop scripts for calling parents when necessary (i.e., in case of immediate threat of
harm).
o Identify and address student language preferences and population-specific barriers to
SBIRT completion.
o Gather any materials needed to support SBIRT, such as binders for the screening team.
These binders might include:
▪ Copy of the “Orange Card” pocket guide to SBIRT (Appendix K)
▪ Copy of the introduction script
▪ Copy of the CRAFFT+N (in English as well as other languages)
▪ Educational materials for students
▪ Consent forms to disclose information
▪ Scripts for calling parents
▪ Referral resources
- Inform students and parents before conducting SBIRT.
o Send a parent/guardian letter outlining SBIRT process before the start of school year (see
Appendix L for an example). Information about opting out must be included in this letter.
Also, consider how you might communicate with parents/guardians in other ways, like
automated phone calls, emails, and on your website.
o Communicate with students about SBIRT. Consider using an assembly or announcement
for the specific grade going through SBIRT. Students do not need as much advance notice
as parents, but they should be aware that SBIRT will be incorporated as part of their
routine health screenings.
- Ensure SBIRT team members have participated in training as required by MDPH.
o See the SHIELD and MASBIRT TTA websites for training resources. Plan for ongoing training
of current and new personnel, as needed.
- Review confidentiality policies and procedures and revise as needed.
o Ensure parents/guardians and students have been informed of the policies.
o Ensure school personnel have been informed of the policies.
o Establish a process to obtain written consent to disclose information. A sample consent
form is available in the Appendices.
Step 3: Refinement and Sustainability
After completing your verbal substance use screening program each year, evaluate your processes and
document best practices for sustaining SBIRT long term.
Objectives:
- Document SBIRT plans each year.
- Schedule a post-SBIRT debrief meeting.
o This meeting should include your SBIRT team and any other key stakeholders, and should
be scheduled to occur right after conducting your screening program. There is a debrief
document and description of this process available on the MASBIRT TTA website.
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- Determine a plan for sustainability and fidelity to SBIRT process.
o Determine on-going staff training needs.
o Review and revise school policies and procedures to include SBIRT.
- Survey stakeholders for feedback regarding SBIRT process.
Parent/Guardian Notification and Opt-out Procedure
Parents and students both have the right to opt out of SBIRT at any time. This should be outlined in the
parent letter and should be communicated to students before conducting the SBIRT. The parent letter may
also include resources for talking to teens about substance use, as well as the screening tools and materials
used for the verbal screening process. Schools must ensure a delivery method that will reach parents in
the district. Some schools use principal newsletters, first day packets, and other effective methods of
communication for the school population.
SHIELD’s SBIRT in Schools online training module was designed for all audiences, and may be used as a
training resource for parents/guardians that want more detailed information. See the SHIELD website for
details.
A sample parent letter can be found in Appendix L.
SBIRT Team and Key Stakeholders
The success of the SBIRT program depends on close collaboration between team members, good
communications with students, families, and key stakeholders, careful attention to protecting student
privacy and confidentiality, and fidelity to protocols. Planning and implementing a successful SBIRT
program requires that school teams make connections with key community stakeholders to support their
efforts. Each stakeholder brings important perspective in preventing and reducing substance use behaviors
in adolescents. Appendix I describes stakeholders and their roles.
Data Collection and Reporting Requirements
Remember that schools may not make a record of any statement, response, or disclosure by a student
during the screening that identifies the student. Schools must keep any student responses to the screening
confidential, except if a parent or guardian requests the information disclosed during a screening, in cases
of immediate medical emergency, or when a disclosure is otherwise required by state law. Schools may
not disclose any information obtained in a screening in a way that identifies the student to any other
person without the prior written consent of the student, parent, or guardian. The DPH-approved sample
consent form is shown in Appendix H.
Schools must report de-identified screening information to DPH. Schools are required to submit SBIRT data
to DPH no later than 90 days after completion. The data needs to be tabulated by grade level before it is
submitted to DPH. Once the data has been tabulated, it is submitting using the DPH online data collection
tool. Instructions for using the tool are provided in Appendix N.
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Providing Substance Use Education and Feedback
Substance use education should be delivered to students to reinforce healthy decisions or to educate and
inform students about the potential risks of using alcohol and other drugs.
Fact sheets on substance use topics (i.e., tobacco, nicotine, alcohol, marijuana, prescription drug misuse)
are available from a number of sources.
• Centers for Disease Control and Prevention (CDC) produces fact sheets like the one pictured here.
• The National Institute on Drug Abuse (NIDA) maintains excellent information as well, and has a
section specific to children and teens.
• BSAS, OYYAS, and the Massachusetts Health Promotion Clearinghouse offer a variety of
publications on teen substance use for health professionals and families.
SHIELD maintains the most current links to these resources on its website. Key educational information on
tobacco, nicotine, marijuana use, and alcohol that SBIRT screening teams may find helpful is listed
Appendix M.
Source:https://www.cdc.gov/marijuana/pdf/Mari
juana-Teens-H.pdf
Source: https://massclearinghouse.ehs.state.ma.us/PROG-
TOB/TC3485.html
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Appendix A: MGL Chapter 71, Section 96
An Act Relative to Substance Use, Treatment, Education and Prevention was signed into law on March 14,
2016, as Chapter 52 of the Acts of 2016. MGL Chapter 71, section 96, as amended by St. 2016, c. 52, s. 15,
requires each school district to develop and file with DESE a policy regarding substance use prevention and
the education of its students about the dangers of substance abuse. We are pleased to report that as of
December 2017, 99% of districts have submitted their policies to ESE.
Chapter 52, AN ACT RELATIVE TO SUBSTANCE USE, TREATMENT, EDUCATION AND PREVENTION
Section 96. Each public school shall have a policy regarding substance use prevention and the education of
its students about the dangers of substance abuse. The school shall notify the parents or guardians of all
students attending the school of the policy and shall post the policy on the school's website. The policy,
and any standards and rules enforcing the policy, shall be prescribed by the school committee in
conjunction with the superintendent or the board of trustees of a charter school.
The department of elementary and secondary education, in consultation with the department of public
health, shall provide guidance and recommendations to assist schools with developing and implementing
effective substance use prevention and abuse education policies and shall make such guidance and
recommendations publicly available on the department’s website. Guidance and recommendations may
include educating parents or guardians on recognizing warning signs of substance abuse and providing
available resources. Guidance and recommendations shall be reviewed and regularly updated to reflect
applicable research and best practices.
Each school district and charter school shall file its substance use prevention and abuse education policies
with the department of elementary and secondary education in a manner and form prescribed by the
department.
Section 97. (a) Subject to appropriation, each city, town, regional school district, charter school or
vocational school district shall utilize a verbal screening tool to screen pupils for substance use
disorders. Screenings shall occur on an annual basis and occur at 2 different grade levels as recommended
by the department of elementary and secondary education, in consultation with the department of public
health. Parents or guardians of a pupil to be screened pursuant to this section shall be notified prior to the
start of the school year. Verbal screening tools shall be approved by the department of elementary and
secondary education, in conjunction with the department of public health. De-identified screening results
shall be reported to the department of public health, in a manner to be determined by the department of
public health, not later than 90 days after completion of the screening.
(b) A pupil or the pupil’s parent or guardian may opt out of the screening by written notification at any
time prior to or during the screening. A city, town, regional school district, charter school or vocational
school district utilizing a verbal screening tool shall comply with the department of elementary and
secondary education’s regulations relative to consent.
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(c) Any statement, response or disclosure made by a pupil during a verbal substance use disorder screening
shall be considered confidential information and shall not be disclosed by a person receiving the statement,
response or disclosure to any other person without the prior written consent of the pupil, parent or
guardian, except in cases of immediate medical emergency or a disclosure is otherwise required by state
law. (See insert with 2018 amended language below) Such consent shall be documented on a form
approved by the department of public health and shall not be subject to discovery or subpoena in any civil,
criminal, legislative or administrative proceeding. No record of any statement, response or disclosure shall
be made in any form, written, electronic or otherwise, that includes information identifying the pupil.
(d) The department of elementary and secondary education shall notify each school district in writing of
the requirement to screen students for substance use disorders pursuant to this section. School districts
with alternative substance use screening policies may, on a form provided by the department, opt out of
the required verbal screening tool. The form shall be signed by the school superintendent and provide a
detailed description of the alternative substance use program the district has implemented and the
reasons why the required verbal screening tool is not appropriate for the district.
(e) No person shall have a cause of action for loss or damage caused by an act or omission resulting from
the implementation of this section.
[Subsection (c) as amended by 2018, 208, Sec. 25 effective August 9, 2018. For text effective until August
9, 2018, see above.]
(c) Any statement, response or disclosure made by a pupil during a verbal substance use disorder screening
shall be considered confidential information and shall not be disclosed by a person receiving the statement,
response or disclosure to any other person without the prior written consent of the pupil, parent or
guardian, except in cases of immediate medical emergency or a disclosure is otherwise required by state
law; provided, however, that the screening required under this section shall be implemented in accordance
with applicable state and federal laws and regulations pertaining to student confidentiality, including rules
and regulations promulgated pursuant to section 34D. Such consent shall be documented on a form
approved by the department of public health and shall not be subject to discovery or subpoena in any civil,
criminal, legislative or administrative proceeding. No record of any statement, response or disclosure shall
be made in any form, written, electronic or otherwise, that includes information identifying the pupil.
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Appendix B: Introduction to Screening Script
Introduce screening
I would like to ask a few health screening questions about alcohol, other drugs, nicotine, and tobacco use
that we are asking all students in your grade.
Address confidentiality
There is no written record of this screening that includes information that specifically identifies you.
Anything you tell me will be kept as confidential as possible. One reason why this information would not
be kept confidential is if something you say indicates that there is an immediate risk to your safety or
someone else’s safety. Additionally, you, your parent, or your guardian could request the information we
discussed today. In any case, we would figure out next steps for support together. Do you understand?
Ask permission to ask questions
Is it okay to ask you these questions?
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Appendix C: CRAFFT+N Tool Sample
Prior to starting your screening program each year, download the most current version from the
MASBIRT TTA website.
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Appendix D: REACT Worksheet
Responding to Negative Screens for students who report no substance use in the past 12 months.
Step
Concepts
Sample Script
Reinforce
- Acknowledge and affirm healthy
decisions.
- Be genuine and specific about what
the student is doing well.
- Encourage continued abstinence by
using open ended questions to ask
about the student’s reasons for
choosing to refrain from using
substances.
“You’ve decided not to use alcohol,
tobacco, nicotine, and other drugs, which
is one way to protect your health and
safety. Tell me what helps you make
those choices?”
Then reflect back the student’s response.
“So, you don’t use because it could
interfere with your ability to make it onto
the soccer team.”
Educate
- Share information about the health
and safety risks of substance use
during adolescent years.
- Maintain a conversational tone and
select 1-2 talking points based on
the interests and activities of the
individual student.
- Always ask permission before
providing information.
Elicit: “What do you know about the risks
of substance use?”
“Would it be okay if I share some
additional information with you?”
Provide: Share 1-2 factual and relevant
points related to substance use.
Elicit: “What are your thoughts about
that?”
Anticipate
Challenges of
Tomorrow
- Use open ended questions that
explore future barriers to remaining
substance free.
- Briefly ask about potential solutions
or alternatives to those barriers.
- Thank the student.
“What situations could make it difficult
for you to continue to avoid alcohol,
tobacco, nicotine, and other drug use?
How might you handle that?”
“What would you do if you were in a
situation where you were offered
alcohol, tobacco, nicotine, or other
drugs?”
“Thank you for being open to speaking
with me today!”
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Appendix E: Brief Negotiated Interview Worksheet
Step
Sample Script
Build
Rapport
“I’d like to learn a little more about you…
What are important things/hopes/goals in
your life now?”
OR “What is a typical day like for you?”
“How does your use of [X] fit in?”
Explore Pros
& Cons
“What do you like about using [X]?”
“What do you like less about using [X]?”
Explore any problems mentioned in
CRAFFT+N:
“You mentioned… Can you tell me a little
more about that?”
“So, on the one hand you said [pros], and
on the other hand you said [cons]. What do
you make of that?”
Provide
Feedback
Elicit: “What do you know about the risks
of using [X]?”
“Would it be okay if I share some additional
information with you?”
Provide: Share 1-2 factual and relevant
points related to substance use.
Elicit: “What are your thoughts about
that?”
Use
Readiness
Ruler
“On a scale of 1-10, how ready are you to
change any aspect of your [X] use?”
“Why did you choose a [X] and not a lower
number like a 1 or 2?” If 1: “What would
need to happen for you to consider making
a change in your use?”
Reflect back student’s reasons for change.
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Negotiate
Action Plan
“Given our discussion so far, what might
you do?”
When making any suggestions, including
suggestions about referrals, use Elicit-
Provide-Elicit format.
“On a scale of 1-10, how confident are you
that you could meet this goal? Why not a
lower number? What might help you to get
to a higher number? What helped you
succeed with changes in the past? What
obstacles do you anticipate?”
Summarize plan, including any steps
towards change.
“Thank you for being open to speaking with
me today!”
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Appendix F: Referral Types and Sample Scripts
Referral Type
Concepts
Sample Script
Follow-up
with SBIRT
screener
A follow-up between the original
screener and student to continue the
conversation and provide for further
assessment of risk. The student is
agreeing to a follow-up or future
conversation that may include a
scheduled appointment. There is no
consent form indicated for this because
there are no screening results
documented or shared with another
individual.
“I am wondering if it would be okay to
follow up with you in [a few days, weeks]
to see how you are doing with your plan.
What do you think about that?”
“Great! I look forward to seeing you then.”
In-school
referral
(to another
school
professional)
Two types:
Referral: The student will have given
written consent on the MDPH-
approved form to approve disclosure of
screening results to another school
professional. The consent for disclosure
form (which includes no results) would
allow you to share the information
verbally with the receiving professional,
preferably with the student present if
the student wants to be included in the
conversation.
Warm hand-off: Some students may
agree to follow up with another school
professional that is readily available
and the screener does not need to
disclose screening results. In this case a
warm hand-off, or another method of
connecting the student directly with
support from another school
professional, may not require a consent
form if no results or disclosure of
information is given.
Referral: “You have been very open to
having this conversation with me so far,
and I wonder if it could be helpful to
continue talking about this in the future to
explore what you want to do. Ms. M is
very knowledgeable about these things
and is available to meet with students.
Would it be ok if I told Mrs. M what we
talked about today so she could follow up
with you directly?”
“Great! I’ll need you to just give me
written permission to share the
information.” (Student will need to sign
the consent form.)
Warm hand-off: “Mrs. M is actually very
knowledgeable about helping students
think through their options regarding
substance use. If you think it could be
helpful, you can share with her what we
have talked about today. What do you
think? Would it be okay if I called her to
see if she is available to check in with you
briefly today?”
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Out-of-School
Referral
Some students may need outside
referrals if the student’s needs are
beyond what the school can provide. In
these cases, effort should be made to
elicit support from the parent/guardian
prior to engaging with outside referrals,
when parental involvement is in the
best interest of the student. Most of
the time, out-of-school referrals are a
stepwise process.
Community Referral: Based on SBIRT
screening results, students may need to
be referred to outside individuals or
agencies for further assessment,
evaluation, or treatment. Typically,
these referrals will happen after an
initial referral for further assessment
within the school. Outside referrals can
include a range of individuals and
agencies, including the student’s
primary care provider (PCP). The school
professional will need written consent
from the student to disclose any
screening results to outside referrals,
except in the case of immediate
medical emergency.
Emergent: During SBIRT screening,
though rare, there are instances when
there is an obligation of disclosure of
screening results due to immediate
medical emergency or otherwise
indicated by law. In these cases,
parents/guardians or 911 may be
called.
Calling parent: “Is it okay if I share my
thoughts with you? It seems like you could
benefit from some support around your
substance use, and I think it could be
helpful to get your parent (or guardian)
involved. I would like to call your family
and help you begin the conversation. What
do you think? Would you like to stay with
me while I call?” (Always offer to have the
student in the room when calling parents.)
Direct Community Referral: “We have a
substance use counselor in the
school/community and they have a lot of
experience helping teens with substance
use and are available to talk with you.
Would you be willing to give me consent
to talk with them about what you have
shared today so they can reach out to you
and offer more ideas?”
Emergent: “Remember in the beginning
when I said there might be reasons why I
need to share this information with
others? Well, given what you have told
me, I’m concerned about you and need to
take steps to make sure you are safe. I
have some thoughts on what we need to
do right now.” (Share thoughts and be
clear with plan.)
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Appendix G: Referral Resources
BSAS has a dedicated office for the oversight of state-funded, substance use-related services for youth
and young adults ages 8-26, called the Office of Youth and Young Adult Services (OYYAS). OYYAS
oversees the implementation, enhancement, and sustainability of developmentally tailored services
including: intervention, treatment, and recovery supports. The Massachusetts Tobacco Cessation and
Prevention Program focuses on comprehensive approaches to reduce tobacco and nicotine use and
provides a variety of resources and supports, including a helpline to connect to trained quit coaches.
The OYYAS website is: https://www.mass.gov/service-details/youth-and-young-adult-services
OYYAS and the Department of Mental Health developed this website, Hand Hold, for parents:
https://handholdma.org/
Massachusetts Substance Use Helpline: 1-800-327-5050 www.helplinema.org/for-parents/
Massachusetts Tobacco Cessation and Prevention Program: Take the first step toward a nicotine free
life Quitline 1-800-QUIT-NOW https://www.mass.gov/take-the-first-step-toward-a-nicotine-free-life
Schools needing additional support around referrals to treatment after a positive SBIRT screen should
consider contacting their local Adolescent Community Reinforcement Approach (A-CRA) provider
listed on the Massachusetts Substance Use Helpline https://helplinema.org/for-parents/ or by calling
800-327-5050.
For current information about referral resources see SHIELD’s SBIRT in Schools Health Screening
Resources at https://shield.bu.edu/health-screenings.
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Appendix H: Sample Consent to Disclose Confidential Information
School Letterhead or other school identification
SBIRT in Schools
Consent to Disclose Confidential Information
I, ___________________________, give permission for______________________________________
(Name of Student, Parent, or Guardian) (Name/Role of School Professional making disclosure)
to share information with ____________________________________________________ about:
(Name of person or organization to which disclosure is to be made)
___________________________________________________________________________________.
(Nature and amount of information to be disclosed; as limited as possible)
This consent expires automatically if any of the following occur:
___________________________________________________________________________________
(Specify the date, event, or condition upon which this consent expires)
I have been given a copy of this form.
Dated: ___________________ _______________________________________________________
Signature of Student, Parent, or Guardian
_____________________________________________________
Relationship to Student
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Appendix I: SBIRT Stakeholders and Team
Stakeholder
Roles
Possible Actions
Student
Parents/guardians
Students and their families should be
educated about the goals and process of
SBIRT in Schools.
Families should:
• Review the letter sent home about
screening process and review
materials provided
• Review opt out procedure and
contact information
• Review educational materials about
substance use in adolescence
• Discuss SBIRT with their children
prior to screening
Administration
Administrators are important leaders and
facilitators of the SBIRT program. They are
responsible for ensuring the program is
implemented and that it meets all regulatory
requirements.
• Establish a multidisciplinary SBIRT
team
• Support the role of the School
SBIRT Coordinator
• Notify school staff of screening
process
• Collaborate with community
stakeholders
SBIRT Coordinator
The SBIRT Coordinator oversees the
development of SBIRT policies and
procedures and ensuring that the process is
being conducted with fidelity. The SBIRT
Coordinator is commonly the district nurse
leader who has been given the time,
resources, and authority to manage the
program.
• Consult planning checklist
• Collaborate with stakeholders
• Manage day-to-day aspects of
screening, such as: notification of
the screening dates to families,
students, staff; coordinating the
screening process; managing data;
ensuring current screening
materials
School Nurse
The school nurse is a health resource/health
educator, who collaborates with all
stakeholders. In some cases, the nurse may
also need to provide emergency treatment
for substance use in the school until
emergency medical services arrive. These
responsibilities are always performed in
collaboration with other members of the
School Assistance Team.
• Attend SBIRT training
• Conduct individual screenings and
assess for comorbid medical
conditions
• Provide on-site counseling,
including motivational
interviewing or substance use
counseling
• Collaborate with physicians,
parents/guardians
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• Provide brief interventions and
refer as needed
Behavioral Health
Team
(School Social
Workers, School
Adjustment
Counselors,
Guidance
Counselors, School
Psychologists,
School Substance
Use Counselors,
Health Educators)
Trained, licensed school professionals often
conduct SBIRT. The role of counselors, and
behavioral and psychological professionals in
the substance-use screening program may
vary in each district. Such specialists may be
district or school employees, or may provide
services on a contractual basis. For many
school districts, providing intensive substance
use treatment services may not be possible
or warranted.
• Attend SBIRT training and assist
with verbal screening
• Provide assessment, referral, and
follow-up to outside resources, as
needed, for at risk students
• Collaborate with school nurses,
school personnel, and mental
health professionals for ongoing
support of students
• Deliver substance use prevention
education workshops relevant to
adolescent substance use and
misuse for parents and school
personnel
• Provide crisis intervention and
referral as needed
School Assistance
Team (SAT)
The SAT provides the necessary link between
school instructional functions and its
guidance, counseling, and health service
delivery programs. Its primary goal is
prevention and early intervention. Policies
must be developed for the SAT consistent
with MGL and FERPA regulations that govern
public school health records.
• The SAT provides opportunities for
prevention, helps identify school-
wide issues, as well as individual
concerns, refers students to
community resources, provides
ongoing case management, and
recommends policy and program
changes to improve the school’s
climate and educational support
services
Community
Agencies
These groups may include: community
coalitions, health and human service groups,
faith-based organizations, youth groups, civic
organizations, law enforcement, local
healthcare providers, mental health care
providers, and parent organizations.
• Many community organizations can
provide education, funding, or
resources to support at-risk
students and their families
identified through verbal substance
use screening in schools
Athletic Directors
(ADs)
ADs are responsible for ensuring that the
school’s athletic policies meet regulatory
requirements. Athletic personnel should
understand the purpose and nature of
confidential verbal substance use screening
program.
• Review current athletic policies,
and support student healthy
behaviors
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Appendix J: SBIRT Planning Checklist
This document can be used as a checklist to document your school’s plan for conducting SBIRT
each year.
School Year:
Person Completing Form:
Step 1: Formative Planning
❑ SBIRT Team Coordinator:
❑ SBIRT planning team members and roles in school:
❑ Other key stakeholders:
❑ Method of communication with planning team:
❑ Projected timeline for conducting SBIRT:
❑ Internal referral resources:
❑ External referral resources:
❑ Notes from process review or prior year’s debrief meeting:
❑ Notes from relevant data related to adolescent substance use:
Other tasks:
❑ Review school policies and procedures related to SBIRT and substance use
Step 2: Process and Implementation Planning
SBIRT procedures:
❑ Grade:
❑ Date(s) to conduct SBIRT:
❑ Location(s) to conduct SBIRT:
❑ Process for keeping track of students who complete SBIRT:
❑ Names of staff involved in conducting SBIRT (screening students):
❑ Process for pairing students with staff, if any:
❑ Names of personnel involved in referrals or warm hand-offs:
❑ Process for data collection:
❑ Educational materials to be used with students:
❑ Languages needed for SBIRT materials:
❑ Other supportive materials needed for students:
❑ Method and date(s) to inform students and parents ahead of SBIRT implementation:
Other tasks:
❑ Develop scripts for calling parents when necessary
❑ Ensure SBIRT team members have participated in training as required by MDPH
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Step 3: Refinement and Sustainability
❑ Date and time of SBIRT debrief meeting (after SBIRT is conducted):
❑ Plan for surveying stakeholders, if any:
Suggested items to have on hand while screening students:
❑ Laptop/computer for recording de-identified results
❑ Introductory screening statement to read to students
❑ Screening tools in appropriate languages
❑ REACT and BNI conversation guides for reference
❑ Fact sheets for educational use
❑ Readiness ruler
❑ Copies of the consent form
❑ List of current in-school and community resources with contact information
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Appendix K: Orange Card Sample
Prior to starting your screening program each year, download the most current version from the
MASSBIRT website.
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Appendix L: Sample Parent Letter
School District Letterhead
Dear Parent or Guardian,
All Massachusetts public schools must include a verbal substance use preventive screening as part of
their yearly mandated universal health-screening programs. Our district will use the Screening, Brief
Intervention, and Referral to Treatment (SBIRT) protocol with students in grades [7 and 9]. All students
will be asked five questions in private, followed by additional assessment questions when indicated.
Then there will be a one-on-one conversation between each student and a school nurse or counselor.
The purpose of this effort is to prevent, or at least delay, alcohol, tobacco, nicotine, marijuana, or other
drug use. The SBIRT program reinforces healthy decisions and addresses concerns about substance use
to improve health, safety, and success in school.
We will use the CRAFFT+N screening tool, the most commonly used
substance use screening tool for adolescents. All screenings will be held
in private one-on-one sessions with one of the specially trained nurses
or counselors. Students who are not using substances will have their
healthy choices reinforced. When any student reports using alcohol,
tobacco, nicotine, or other drugs, or seems at risk for future substance
use, the screener will provide feedback and have a brief conversation
with that student.
• What your child tells the screener is confidential and will not be shared with any other person
without prior written consent of the student, parent, or guardian, except in cases of immediate
medical emergency, or when disclosure is otherwise required by state law.
• No written record of the results of this verbal screening are kept with information that identifies
any individual student.
• Screening results will not be put with any other information that identifies any child.
• Screening results will not be included in your child’s school record.
If you want to opt your child out of the screening, you can write to us any time before or during the
screening. Your child may also opt out at the time of the screening. Please feel free to contact us with
any questions, or if you would like your child to opt-out of the screening.
Together, schools and parents CAN make a difference for the youth in our community. One way to
prevent youth alcohol, tobacco, nicotine, and other drug use is to talk with your child about your
thoughts and expectations. You can view the CRAFFT+N tool and other SBIRT resources on this website:
www.masbirt.org/schools
Regards, School Principal
School SBIRT Screening IS:
• a short set of questions
School SBIRT Screening IS
NOT a:
• blood or urine test,
• drug test, or
• test of any body function
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Appendix M: Educational Information on Nicotine, Alcohol, & Marijuana
The information below has been organized into three categories; neurobiology, social norms, and injury
to incorporate into conversations with students during SBIRT.
The statements below were extracted from fact sheets and educational materials from the CDC,
Substance Abuse and Mental Health Administration (SAMSHA), and the National Institutes of Health (NIH)
to serve as talking points for information about substance use in teens. Links to these resources are listed
in the References section below and are also maintained on the SHIELD website.
Substance
Educational Information
Nicotine
E-cigarettes are electronic devices
that heat a combustible liquid mix
of small particles of nicotine,
flavorings, and chemicals to
produce an aerosol, or particles for
inhalation.
Most have a battery, a heating
element, and a place to hold a
liquid. Vape pens may look like USB
flash drives, pens, and other
everyday items.
They are sometimes called “e-cigs,”
“e-hookahs,” “mods,” “vape pens,”
“vapes,” “tank systems,” and
“electronic nicotine delivery
systems (ENDS)”
Neurobiology (CDC)
• Nicotine is highly addictive and can harm adolescent
brain development, which continues into the early to
mid-20s.
• When a memory is created or a new skill is learned,
stronger connections – or synapses – are built between
brain cells. Young people’s brains build synapses faster
than adult brains. Nicotine changes the way these
synapses are formed.
• Nicotine use in youth can harm the parts of the brain
that control attention, learning, mood, and impulse
control.
• Nicotine use in adolescence may also increase risk for
future addiction to other drugs.
Social Norms
• E-cigarettes work by heating a liquid that usually
contains nicotine, flavorings, and other chemicals to
create an aerosol that is inhaled into the lungs.
Bystanders can also breathe in this aerosol when the
user exhales it into the air. Some e-cigarette flavorings
may be safe to eat but not to inhale.
Injury
• Scientists are still learning about the long-term health
effects of e-cigarettes.
• Ingredients in e-cigarette aerosol could be harmful to
the lungs in the long-term.
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Substance
Educational Information
• Defective e-cigarette batteries have caused some fires
and explosions, a few of which have resulted in serious
injuries.
• People have been poisoned by swallowing, breathing,
or absorbing e-cigarette liquid through the skin or eyes.
Alcohol
No level of drinking is safe or legal
for anyone under age 21, but
unfortunately many teens drink—
and they often drink multiple drinks,
which is very dangerous.
Alcohol is the most commonly used
substance of abuse among young
people in America, and drinking
when you’re underage puts your
health and safety at risk.
Alcohol includes beer, wine, and
liquor. Different types of alcohol
have varying levels of potency.
Neurobiology (SAMSHA)
When teens drink, alcohol affects their brains in the short-term,
but repeated drinking can also impact it down the road,
especially as their brains grow and develop.
• Drinking during the teen years could interfere with
normal brain development, change the way the brain
processes and learns information, and increase the risk
of developing an alcohol use disorder later in life.
• Young people who drink are more likely to have health
issues, such as depression and anxiety disorders.
• According to NIH, alcohol has been identified as a
human carcinogen associated with head, neck,
esophageal, liver, and breast cancers, and it weakens
immune system.
• Youth who use alcohol have higher rates of academic
problems and poor school performance compared with
non-drinkers.
Social Norms (SAMSHA)
• A person may have difficulty recognizing potential
danger and making good decisions when drinking
alcohol. They may be more likely to engage in risky
behavior, including drinking and driving, sexual activity
(like unprotected sex), and aggressive/violent behavior.
• Drinking lowers inhibitions and increases the chances
that youth will do something that they will regret when
they are sober.
• Frequent binge drinkers (nearly 1 million high school
students nationwide) are more likely to engage in risky
behaviors, including using other drugs, such as
marijuana and cocaine.
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Substance
Educational Information
Injury (NIH)
• Alcohol interferes with the brain’s communication
pathways, and can affect the way the brain looks and
works. These disruptions can change mood and
behavior, and make it harder to think clearly and move
with coordination, causing accidents or injury.
• Alcohol poisoning (also called alcohol overdose) occurs
when there is so much alcohol in a person’s
bloodstream that areas of the brain controlling basic
life-support systems—such as breathing, heart rate, and
temperature control—begin to shut down. If you
suspect someone has alcohol poisoning, call 911 and
get medical help immediately.
Marijuana
There are several different methods
of using marijuana and an abundant
number of plant strains with a large
range of THC potency. It is
important to understand the
frequency, age of onset, potency,
and method of teen use including:
Smoke
Vape
Dab
Edible
Topical
➢ Weed: buds of plant usually
smoked, rolled, or edible
➢ Resin (”hash”): solid preparation
of the plant that is shaped into
blocks or individual doses
➢ Oil or tincture-extracted from
plant: most potent, for vaping.
Neurobiology (CDC)
Scientists are still learning about what marijuana does to brain
development.
• When marijuana users begin using as teenagers, the
drug may reduce attention, memory, and learning
functions and affect how the brain builds connections
between the areas necessary for these functions. It can
affect memory, learning, and attention, and make
problem solving harder.
• Heavy users of marijuana can have short-term problems
with attention, memory, and learning, which can affect
relationships and mood.
• Marijuana’s effects on these abilities may last a long
time or even be permanent. This means that someone
who uses marijuana may not do as well in school and
may have trouble remembering things.
Social Norms
• About 1 in 10 marijuana users will become addicted.
For people who begin using before the age of 18, that
number rises to 1 in 6.
• Some people who are addicted need to smoke more
and more marijuana to get the same high. It is also
important to be aware that the amount of
tetrahydrocannabinol (THC) in marijuana (i.e.,
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Substance
Educational Information
➢ Dab: extraction of THC CBD
concentrate in solvent for
smoking in a pipe.
marijuana potency or strength) has increased over the
past few decades.
Injury
• Edibles, or food and drink products infused with
marijuana and eaten, have some different risks than
smoking marijuana, including a greater risk of
poisoning. Unlike smoked marijuana, edibles can take
up to 2 hours to take effect, so some people ingest too
much, which can lead to poisoning and/or serious
injury.
• Smoked marijuana, in any form, can harm lung tissues
and cause scarring and damage to small blood vessels.
Smoke from marijuana contains many of the same
toxins, irritants, and carcinogens as tobacco smoke, and
can lead to a greater risk of bronchitis, cough, and
phlegm production.
• Secondhand marijuana smoke contains THC and many
of the same toxic compounds in tobacco smoke, so it
could affect anyone who breathes it in, especially
pregnant women, babies, and children.
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Appendix N: Submitting SBIRT Data Using Online Data Collection Tool
The first page of the online data collection tool has detailed instructions for using the tool, saving a copy
of your data, editing data, and other data submission issues. A link to the data report is provided in
SHIELD’s MDPH Health Services Resources section located here: https://shield.bu.edu/mdph-school-
health-services.
When entering data, you will be asked if you are a CSHS-funded district, and what type of data you want
to enter (see item 9b below). You will only see the data entry screens that apply to the option you select.
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SBIRT Data: Number of screeners; grades screened
The first SBIRT questions ask about the number of screeners and the grades that were screened. After you
enter that information, you will see separate data entry pages for each of the grades you screened.
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SBIRT Data: Students
The SBIRT data for each grade will need to be entered separately. Do not mix the data from different
grades together. There will be a separate page for each grade screened. For example, if you screened
grades 9 and 11, after all grade 9 data is entered, another screen will appear where you can enter grade
11 data. The screenshots on the following pages show an example of the data entry pages for grade 9.
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Grade 9 SBIRT Data: CRAFFT+N Part A
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SBIRT Data: CRAFFT+N Part B
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Data Collection Worksheet
The School Health Unit annually issues a worksheet to assist with SBIRT data collection. A sample for FY22
follows. For the most recent copy, see the MDPH Health Services section in SHIELD’s resources.
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References
Centers for Disease Control and Prevention (CDC). Quick Facts on the Risks of E-cigarettes for Kids,
Teens, and Young Adults. Available at https://www.cdc.gov/tobacco/basic_information/e-
cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html
CDC. Marijuana: How Can It Affect Your Health? Available at: www.cdc.gov/marijuana/health-
effects.html
CDC. Marijuana and Public Health: Data and Statistics. Available at:
https://www.cdc.gov/marijuana/data-statistics.htm
Knight, J.R., Sherritt, L., Shrier, L.A., Harris, S.K., Chang, G. (2002). Validity of the CRAFFT substance abuse
screening test among adolescent clinic patients. Arch Pediatr Adolesc Med, 156, 607-14.
Levy, S., Sherritt, L., Harris, S.K., Gates, E.C., Holder, D.W., Kulig, J.W., Knight, J.R. (2004). Test-retest
reliability of adolescents' self-report of substance use. Alcohol Clin Exp Res, 28, 1236-41.
National Institute on Drug Abuse for Teens (NIDA). Alcohol. Available at
https://teens.drugabuse.gov/drug-facts/alcohol
National Institute on Alcohol Abuse and Alcoholism (NIAAA) Alcohol’s Effects on the Body. Available at:
https://www.niaaa.nih.gov/alcohol-health/alcohols-effects-body
Substance Abuse and Mental Health Administration (SAMHSA). The Consequences of Underage Drinking.
Available at https://www.samhsa.gov/underage-drinking/parent-resources/consequences-
underage-drinking
US Department of Health and Human Services (2016) E-Cigarette Use Among Youth and Young Adults: A
Report of the Surgeon General. Available at:
https://www.cdc.gov/tobacco/data_statistics/sgr/e-
cigarettes/pdfs/2016_sgr_entire_report_508.pdf