In 2013, the Conrad N. Hilton Foundation established the Youth Substance Use Prevention and Early Intervention Strategic Initiative to promote early detection and intervention of adolescent substance use through testing and implementation of the screening, brief intervention and referral to treatment (SBIRT) framework. Abt Global serves as the Foundation’s Monitoring, Evaluation and Learning partner. This annual report found that feasibility and effectiveness of youth SBIRT rely on concerted change in the systems that interact with youth. Key lessons include:  

• All youth-serving systems could serve youth by adapting the SBIRT framework to their unique landscape.
• Providers require training tailored to their practices so that they feel confident they can conduct an effective discussion with youth related to substance use.
• Reimbursement for SBIRT must change to align with emerging healthcare payment models.
• Mental health and substance use disorder treatment systems for youth are inadequate, and sometimes almost nonexistent, and require integration of care for mental health and substance use disorders.