This paper explores how the Conrad N. Hilton Foundation’s Substance Use Prevention Initiative has advanced the knowledge base for adolescent substance use screening, brief intervention, and referral to treatment (SBIRT). To inform future discussions about youth substance use prevention policy and practice, this paper discusses the Initiative’s contributions to the substance use prevention field.

SBIRT is an evidence-based approach to identifying and addressing substance use and related risks among youth. In the SBIRT framework, youth are screened to identify potential risk and provided a brief counseling intervention or a referral to specialty treatment services if screening indicates a more acute need. SBIRT is designed to be a brief, stepped approach that can be administered in a variety of settings by youth-serving providers and can screen a large number of individuals who might otherwise go unnoticed until untoward consequences of use occur.

Since 2013, the Foundation has awarded more than $75 million to fund the work of 54 grantees. Several overarching lessons have emerged from the Foundation’s past five years of substance use prevention grant making:

1. Successful implementation of the SBIRT framework in the settings that provide access to large numbers of youth is achievable. Schools and school-based health centers screened 42,904 youth, pediatric primary care settings screened more than 37,500, community-based organizations and community behavioral health organizations screened more than 9,000, and nearly 500 youth were screened in juvenile justice programs.

2. The need to screen youth in a wide variety of settings to identify risk for substance use is critical, as a substantial proportion of screenings in these settings indicated a need for brief intervention (12%) or specialty treatment for substance use disorder (2%).

3. Many youth-serving providers feel unprepared to address substance use risk because of lack of knowledge about how to address substance use, limited reimbursement options for services, and issues related to confidentiality. SBIRT training and technical assistance can mitigate some of these barriers.

4. Referral to specialty treatment for substance use disorder presents a challenge in terms of limited or even absent treatment resources for youth in many areas. Referrals thus require active development of provider networks and additional services and support for youth.

5. Prevention and early intervention of youth substance use requires a multifaceted approach, including concurrent identification and intervention for mental health concerns and other risk factors.

The Foundation ultimately succeeded in 1) introducing SBIRT into places youth can easily access, 2) preparing the provider field to identify and address substance use effectively, and 3) disseminating findings to the broader field. The Initiative has accomplished noteworthy results, including demonstrating that simple screening techniques can reach large numbers of youth and that brief interventions can address early risk. In addition, the provider field is ready to adopt the effective training and SBIRT curricula that the Foundation has developed and distributed.