My health, my future: Self-guided behavioral health screening and intervention for middle school students
Lake Washington School District (LWSD) is committed to the well-being of each and every one of its students. The student experience at our schools provides an opportunity to highlight the strengths of all our children in this community. School also provides an excellent opportunity to proactively support students in building skills to promote positive behavioral health and prevent substance abuse issues.
That’s why LWSD is teaming up with several reputable local partners to implement a screening and intervention system at the middle school level.
It’s all about balance. In addition to the support of parents, teachers and others, this screening is one element that can help navigate students through this unique time in their lives. Use the Frequently Asked Questions (FAQ) section below to help answer any questions you may have about this screening and intervention program.
- What model of care will be used?
- How will the school work with students around goals and growth?
- Where can students be connected?
- How does the Lake Washington School District plan on implementation in middle schools?
- How will parents be informed about the screening?
- Is taking the screener and participating in a brief intervention voluntary?
- Who will be screened and when will screening occur?
- How will student information be kept private?
- What is the screening tool?
- What type of questions does the screening tool ask students?
- How are students identified to meet with a support team member?
- How was the screener developed?
The Lake Washington School District will be using an evidence-based practice model known as SBIRT that has been modified to be used within the school setting. SBIRT stands for: Screening, Brief Intervention, and Referral To services.
Screening is done through the Check Yourself tool developed by Seattle Children’s Hospital and the University of Washington with Tickit Health. The screening asks students questions about their strengths, goals, mental health, substance use and safety.
Based on screening results, the school counseling team, in partnership with behavioral health specialists from Youth Eastside Services, will connect with students who indicated higher levels of risk or requested additional support. Students may receive a brief intervention of several sessions with their school counselor based on motivational interviewing principles.
Students at elevated levels of risk may be referred to providers in the community for additional supports.
The brief intervention model being utilized for this school based version of SBIRT was developed by Reclaiming Futures. The model includes 4-5 brief intervention meetings that are designed to be about 15-20 minutes each. The primary goal of these meetings is to elevate a student’s awareness of potential areas for growth and change. The brief intervention model is grounded in a collaborative counseling approach known as Motivational Interviewing (MI). This means that each of these brief meetings are designed to be completed in partnership with the student and are focused on what the student values and deems as important.
A typical course of brief intervention meetings begins with the SBIRT interventionist reviewing responses on the Check Yourself screening tool with the student. This conversation involves discussing a student’s strengths, goals, and positive coping, in addition to discussing areas of struggle and potential safety concerns. If a student’s responses during this initial meeting indicate that they would benefit from continuing to meet with the SBIRT interventionist then a second meeting will be discussed and scheduled with the student. Students have the right to decline continued participation in the brief intervention process. Caregivers or parents will also be notified of any concerns that warrant their immediate participation in the intervention process, such as recent suicidal ideation.
Subsequent meetings following this initial review of a student's responses entail evoking from the student what their goals are and how their current behavioral health concern(s) and/or substance use are impacting their ability to successfully meet their goals. Student’s may be asked to rate their readiness for change and discuss why they are motivated or not motivated to change behaviors interfering with their goals. A student who demonstrates a willingness to make a change in behavior may be asked to develop a plan for change or, if they are not ready, develop a plan for how they may go about change should they decide that change is necessary. The idea of involving a caregiver or parent in a student's change process is generally brought up towards the end of the brief invention process, and a meeting or phone call are scheduled, if needed.
Below is a sample of the different brief intervention elements that may be incorporated in a meeting with a student. Please note that not all elements will be covered with each student that screens-in following the Check Yourself screener.
Element 1: The Check Yourself tool results are reviewed with the student. Safety concerns are addressed and a second meeting scheduled, if necessary.
Element 2: A student is asked to discuss their goals and values, and how current behaviors may be impacting their ability to attain their goals or live a life aligned with their values.
Element 3: A student is prompted to discuss their current level of readiness for change and why they are giving themselves a certain “readiness rating.”
Element 4: A student devises a plan for change with the help of the SBIRT interventionist. The interventionist broaches the idea of caregiver involvement to support the student.
Element 5: Caregiver meets with the SBIRT interventionist and student to discuss how they can support their student in succeeding, which may include a referral to services or connecting the student to resources in school.
A “referral to” services can be made at any time during the SBIRT meeting process or not all. Some students who will screen in from the Check Yourself screening tool will already be connected with services and will only need to meet with an interventionist once to ensure they are getting the support they need. Other students benefit from multiple brief meetings with an interventionist until they are ready to engage in services whether that is starting counseling, being connected to a mentor, or joining a club at school. A referral can really be to any service, agency, group, or organization that could benefit the student in best meeting their goals.
Students and their families also have the right to decline referrals to services and can stop brief intervention meetings at any time. In short, a referral is specifically tailored to the needs of a student and can be made at any time during the brief intervention process depending on the student’s motivation and/or desire to connect with services.
The SBIRT interventionist can additionally assist families in connecting with services that they may not have previously been aware of and can help facilitate dialogue between students and their caregivers about what is best for the student and their family.
LWSD is currently in the planning stages of this process. The district began piloting SBIRT during the 2018-2019 school year as counseling teams are provided training and as additional supports are put into place. LWSD is working closely with King County and Seattle Children’s to monitor the implementation of SBIRT to ensure its effectiveness.
Parents and students will be notified in advance of the screener being administered similar to how parents and students are notified about the Healthy Youth Survey.
Parents will also be notified if the screener indicates high levels of risk and in instances where the counseling team is referring the student to supports within the community.
Yes, the entire process is voluntary. Parents and caregivers are notified two weeks before the screening takes place and can simply contact the school counseling team to opt-out their student. If a student is not participating in taking the Check Yourself screener, they may work quietly or read in class. Their grades and participation will not be affected. On the day of the screener, students also have the option to opt out as well. Students are informed before they start the screener about confidentiality and who has access to their information. They have the option to select “accept” or “decline” before starting the interactive online tool, Check Yourself.
LWSD is considering using the Check Yourself tool as a universal screener, which means it would eventually be taken by all students at a particular grade level. During the pilot year, the use of the screener will be more limited.
Screening will be staggered throughout the year so additional supports from Youth Eastside Services can be brought into the school to help ensure student concerns can be addressed quickly and appropriately.
Students can opt out of the screener, just as they can opt-out of the Healthy Youth Survey.
The tool is a HIPAA compliant, interactive, web-based survey that collects individual student data and provides them with instant personalized feedback about mental health behaviors. Only direct providers, like the school counselor, nurse or interventionist will have access to identifiable student information. All providers are required to follow regulations and protect student information at all times.
Check Yourself School-based tool is an interactive electronic screening tool that gives teens personalized feedback and strategies for staying healthy. It also gives the school support team key information about the student. The goal of the tool is to help spark conversations between teens and their support team that motivate teens to make healthy choices.
Youth involvement in the development of the tool has been essential in ensuring the information is applicable and engaging. Electronic screening via Check Yourself School-based can increase teen comfort and honesty and remove bias in how questions are asked.
The personalized feedback includes research-based motivational strategies to help teens set their own goals and start thinking about opportunities before meeting with a school counselor.
The SBIRT process is completely voluntary and students can opt out at any time. The first question on the Check Yourself tool allows student to “accept” or “decline” participation. They are informed in writing about confidentiality. If the student declines, their participation in the process ends. If the student “accepts” to participate, they are asked their current age and grade.
The Check Yourself tool is then divided into three main categories of questions for students to answer: about me, health and safety and stress and coping.
The first of the three categories is the “About Me” section. Students are asked general demographic questions such as language spoken at home and race/ethnicity. Students can choose whether or not to answer questions about their gender identity and sexual orientation. In this section, students are also asked about their goals and biggest supports in their life.
The second category is “My Health & Safety”, where students are asked questions about experiences at home and getting along with others. It asks how they feel about their safety at school, including bullying or harassment in real life or on social media, and if they experience frequent aches and pain. Students are asked about their use of substances including: alcohol, marijuana, e-cigarettes, tobacco, other drugs), perception of use among their peers and their likelihood to use substances in the future.
The third and final category within the Check Yourself tool is “My Stress & Coping”. In this section, students identify activities they are good at and activities they turn to when times are tough. It asks them if they have adults they trust in school and outside of school. There are several questions about symptoms of anxiety and depression, as well as asking about self-harm and suicidal ideation. Students can select from a variety of emojis to indicate how they feel most days as well as how they feel about the future.
After answering the questions about their experiences, students are provided feedback based on their specific answers. Feedback includes information about sleep, substance use and emotions. Students can let the support teams know if they are currently seeing a counselor or therapist or if they would like to talk to one right away or within a few weeks.
The questions asked in the Check Yourself tool aim to not only identify possible symptoms that a student might be experiencing, but also provide context and identify existing supports and strengths. The questions are designed to start a conversation with students about their health and wellbeing, providing tailored and compressive supports when necessary in the brief intervention and referral process.
Certain questions and answers are identified for follow-up with the student support team using a tiered system. Tier 2 indicates the need for a scheduled follow-up (within two weeks) and Tier 3 indicates the need for immediate follow-up (day of or next day) with the student. If there is any indication from the screening tool or from follow-up conversations about a student’s intent to harm themselves or others, staff will follow existing policies and, as they already do, contact parents/caregivers. Below are some examples of what types of responses fall under each tier:
- Reported use of substances in the last school year
- Reported somatic symptoms (frequent aches and pains)
- Reported depression symptoms
- Reported anxiety symptoms
- Wants to speak with a counselor confidentially within the next few weeks
- Reports intention (maybe or likely) to use marijuana or alcohol in the next year
- Feels harassed or threatened in some way in the past year but safety is NOT at risk
- Reports experiencing any symptoms from trauma more than one month ago
- Endorses self-harm or suicidal thoughts
- Reports experiencing any symptoms from trauma over the past month
- Reports wanting to speak to a counselor confidentially ASAP
- Feels harassed or threated in some way in the past year AND their safety is currently at risk
Questions in the Check Yourself School-based tool were developed from standardized and evidence-based tools (e.g. PHQ-2, GAD-2), as well as questions taken from the Healthy Youth Survey. A number of questions were also taken from the original Check Yourself tool developed by Dr. Cari McCarty and Dr. Laura Richardson from Seattle Children’s Hospital and the University of Washington with Tickit Health which is currently being used in primary care settings.
Check Yourself School-based has been refined using youth user testing and feedback from behavioral health counselors to ensure that the content and design is relevant and clear for middle and high school-age students.