(80) SBIRT Model to Combine Direct Early Intervention and mHealth for Substance-Involved Youth

Background & Introduction: Through funding from SAMHSA) a team from Azusa Pacific University (APU) launched Project TREE (Enhancement and Expansion of Treatment and Recovery Services) in Los Angeles County catchment areas that experience significant behavioral health crisis needs among at-risk youth populations experiencing co-occurring substance use, mental health and intergenerational family trauma issues. Project TREE improves access gaps to address such issues among youth and family systems by hiring and training Youth Recovery Coordinators to implement SBIRT-early intervention substance use risk reduction services and through an mHealth texting campaign to deliver anti-vaping psychoeducation for those with accessibility issues. Project TREE’s programming utilizes the structured implementation of the SBIRT model as Youth Recovery Coordinators use a screening tool to identify substance use (including tobacco), mental health risks and family functioning (with items adapted from evidence based tools). Upon risk identification, the Youth Recovery Coordinators implement personalized early intervention programming with youth and caregivers utilizing "A HealthyYOUth" award winning Curriculum that includes substance use and mental health risk reduction through psychoeducation, skill building and support facilitation. Appropriate referrals are also made to ASAM levels of SUD treatment as needed.

Methods: A comprehensive screening tool was developed for Project TREE to assist Youth Recovery Coordinators in identifying substance use (including tobacco), mental health risks, and family functioning. The tool was adapted from validated measures, including the CRAFFT 2.1+N, GAD-2, PROMIS Emotional Distress–Anger, McMaster Family Assessment Device (FAD-2), PHQ-3 with a Columbia-Suicide Severity one-item screen, and ASAM 0.5 functioning domains. Project TREE also employs SAMHSA’s CSAT GPRA Client Outcome Measures for Discretionary Programs Questionnaire to assess outcomes across seven domains: (1) demographics, (2) past 30-day substance use, (3) living conditions, (4) education, employment, and income, (5) legal status, (6) mental and physical health, and (7) social connectedness. GPRA data are collected at baseline, discharge, and 3- and 6-month follow-ups.

Participants were recruited from three HYC sites—Liberty Community Plaza, Whittier CRC, and the Commerce site near East Los Angeles—through Recovery Support Coordinators who facilitated early intervention, treatment, and recovery support services. Prior to enrollment, youth completed screenings for substance use, emotional well-being, family functioning, and suicidality. Following screening, the GPRA baseline was administered, services were delivered, and subsequent follow-ups occurred three and six months post-intake, with a discharge GPRA completed at program exit.

Results: Since June 2024, a total of 143 youth have participated in Project TREE. The average age of the youth is Mage = 15.8, SDage = 2.4, range 13-24. There are slightly more male (58.7%) than females (38.5%) that participated in TREE. Most youth identified as Hispanic, Latino/a, or of Spanish origin (87.4%), with over half (53.1%) reporting speaking Spanish at home. All of the youth enrolled (n=143) completed a baseline outcome GPRA and additional mental health and family functioning screening (note n=9 did not complete). All of the youth were identified to have substance use risk (reporting a variety of substances spanning alcohol, marijuana, methamphetamine, sedatives, hypnotics, MDMA, synthetic cannabinoids anxiolytics, and tobacco), with almost half (47.8%) screening positive for having co-occurring emotional and family support challenges. Generalized Linear Mixed Models (GLMMs) were utilized to examine improvements in substance use, mental health and social outcomes using GPRA data from discharge, 3-month and 6-month follow-ups. Note: follow-up retention rates for Project TREE remain high: nearly all discharged youth completed the 3-month follow-up (N=41, 97.6%), and 75.6% (n=31) completed the 6-month follow-up. Youth who participated in Project TREE early intervention services had good retention as 75% retained for at least 61 days (~2 months), 50% stayed more than 101 days (~3.5 months), and 25% stayed enrolled for over 149 days (~5 months). Overall, findings showed that youth who participated in Project TREE had significant substance use reductions (in reported number of days during the past month) overtime from baseline across discharge and follow-ups (3- and 6-month) in the following: alcohol (p < 0.05 for 3-month and 6-month follow-ups; marijuana, methamphetamines, sedatives, hypnotics, and MDMA (p < 0.05 across all time points); synthetic cannabinoids (p < 0.05 at discharge and 6-month); anxiolytics (p  <.0001 at discharge and 3-month), and tobacco (p  <.0001 at discharge and p = 0.059 at 3-month follow-up). There were also significant improvements in mental health outcomes, including emotional distress (p < 0.05 at discharge and 6-month), anxiety symptoms (p < 0.05 at discharge and 3-month), and violent behaviors (p <.05 at 3-month). Analyses also revealed a trend in improved depressive symptoms, hallucinations, and psychiatric medication use (p>0.10). Additionally, youth reported improved perceived quality of life at discharge (p < 0.05) and improvement in social connectedness at 6-month follow-up (p = 0.0513).

Conclusion & Discussion: Results from Project TREE demonstrate the effectiveness of using a SBIRT model within early intervention service programming for addressing co-occurring substance use and mental health risks among at-risk youth in community settings by Youth Recovery Coordinators. In addition, results underscore the importance of family engagement in early intervention support services for achieving improved youth participation in services (retention) and outcomes across mental health, social connectedness and substance use overtime, as an initial limitation was lack of family participation. The elevated ICE activity in Los Angeles County also posed a challenge, as several families reported fear of deportation due to undocumented caregiver status. Future directions for Project TREE will include expansion of early intervention services to target additional at-risk in the community (e.g., unhoused and justice-involved) to address the ongoing rise of COD complications within Los Angeles County.

References: Agerwala, S. M., & McCance-Katz, E. F. (2012). Integrating Screening, Brief Intervention, and Referral to Treatment (SBIRT) into Clinical Practice Settings: A Brief Review. Journal of Psychoactive Drugs, 44(4), 307–317. https://doi.org/10.1080/02791072.2012.720169

Mitchell, S. G., Gryczynski, J., O'Grady, K. E., & Schwartz, R. P. (2013). SBIRT for adolescent drug and alcohol use: Current status and future directions. Journal of Substance Abuse Treatment, 44(5), 450-454. [https://doi.org/10.1016/j.jsat.2012.11.005](https://doi.org/10.1016/j.jsat.2012.11.005)

Substance Abuse and Mental Health Services Administration. (2024). Screening, Brief Intervention, and Referral to Treatment (SBIRT). SAMHSA.gov. [https://www.samhsa.gov/substance-use/treatment/sbirt](https://www.samhsa.gov/substance-use/treatment/sbirt)

Sterling, S., Parthasarathy, S., Jones, A., Weisner, C., Metz, V., Hartman, L., Saba, K., & Kline-Simon, A. (2022). Young Adult Substance Use and Healthcare Use Associated with Screening, Brief Intervention and Referral to Treatment in Pediatric Primary Care. Journal of Adolescent Health, 71(4), 15-23. https://doi.org/10.1016/j.jadohealth.2021.11.033.

Parthasarathy S, Kline-Simon AH, Jones A, Hartman L, Saba K, Weisner C, Sterling S. (2021).Three-Year Outcomes After Brief Treatment of Substance Use and Mood Symptoms. Pediatrics, 147(1):e2020009191. doi: 10.1542/peds.2020-009191. PMID: 33372122; PMCID: PMC7786828.