Playing Offense: Behavioral Health Interventions During Adolescence Is Our Best Shot

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professional headshotIn the behavioral health field, it is clear that the most high-stakes developmental period is adolescence, when mental illness and substance use problems often emerge. During adolescence, experimentation or risky use of substances can eventually progress into addiction, with 90 percent of individuals with substance use disorders reporting that they initiated use of substances before age 18.

Adolescence is also a common developmental window for the onset of mental health problems, with half of all lifetime cases of mental illness beginning by age 14. Behavioral health challenges often interrupt academic pursuits, causing half of students with mental illness to drop out of school, and contribute to involvement with the justice system, supported by findings that 70 percent of those in the juvenile justice system have mental illnesses.

Plain and simple, the vulnerable period of adolescence sets the stage — positively or negatively — for a person’s experience with mental illness and substance use throughout the lifespan, and all the consequences that ensue.

And then, too often, we are forced to play defense, helping people rebuild and recover after developing a substance use disorder and severe mental illness, instead of engaging in prevention and early intervention before a more serious condition begins. As the data above suggests, the most sensible point of entry for prevention and early intervention is adolescence — the developmental period when experimentation crosses into problematic substance use; social determinants culminate into lifelong challenges; and the onset of mental illness interrupts further professional, academic and social development. In short, implementing behavioral health interventions during adolescence is our best shot. We’ve got to continue aggressively playing defense but also step up our offensive game.

But the behavioral health sector can’t do it alone. To effectively address the behavioral health needs of youth, we need the help of every youth-serving organization, a unified front of organizations — along with their workforce — to fully incorporate upstream behavioral health interventions into their ecosystems. Behavioral health can become a part of the DNA of these organizations by implementing real-world strategies — like SBIRT, Youth Mental Health First Aid and trauma-informed care — that fit into routine services.

Implement SBIRT

We can actually play offense when it comes to substance use, detecting substance use earlier and interrupting the path from experimentation or risky use to addiction. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based protocol designed to identify youth and adults who have risky patterns of substance use, deploy brief interventions based on motivational interviewing to negotiate safer use or abstinence, and make referrals to specialty substance use treatment providers, if necessary.

Youth-serving organizations interface with clients every day who are at risk for substance use disorders, and SBIRT provides their staff with the tools and skills they need to employ standardized and routine screenings — and then intervene along the continuum of mild, moderate and heavy drug and alcohol use, even if they are not addiction specialists. The extent to which youth-serving organizations can be effective in providing their services and helping their clients (whether child welfare, housing, academic supports, etc.) is often contingent upon whether they can successfully prevent or intervene early regarding substance use issues.

[Related: Connect the Dots Between Past and Present]

SBIRT has garnered federal support from the Substance Abuse and Mental Health Services Administration (SAMHSA), Health Resources and Services Administration (HRSA) and the U.S. Preventive Services Taskforce, contributing to more widespread adoption of SBIRT among adults and adolescents. In addition, a large investment from the Conrad N. Hilton Foundation* has accelerated the adoption of SBIRT in youth-serving organizations, supporting several national nonprofits — including the School-Based Health Alliance, YouthBuild and the National Council for Behavioral Health — that are incorporating SBIRT into their routine services, and training their workforce, specialists and line staff, on how to be an upstream force against addiction.

Get trained in Youth Mental Health First Aid

Given the ubiquity of behavioral health challenges among the youth we serve, it is important that staff from youth-serving organizations also have the opportunity to acquire a generalist level of knowledge on behavioral health. Youth Mental Health First Aid is an evidence-based training designed to teach community members how to help an adolescent who is experiencing a mental health or addiction challenge, or who is in crisis. The training guides learners through topics such as anxiety, depression, substance use, disorders in which psychosis may occur, disruptive behavior disorders (including ADHD) and eating disorders.

Just as CPR helps community members assist an individual having a heart attack — even if they have no clinical training — Mental Health First Aid helps staff assist someone experiencing a mental health-related crisis, equipping them with knowledge about risk factors and warning signs for mental health and addiction concerns, strategies for how to help someone in both crisis and noncrisis situations, and guidance about where to turn for help.

More than half a million individuals across the nation have been trained in Mental Health First Aid, ranging from law enforcement officers to first lady Michelle Obama, and the National Council for Behavioral Health endeavors to double that number through their Be 1 in a Million campaign.

Create trauma-informed environments

Trauma-informed care is especially important among youth-serving organizations, as the Adverse Childhood Experiences Study revealed that, in order to improve our efforts toward prevention and recovery, we must understand the relationship between certain childhood experiences — like abuse, neglect and family dysfunction — and poor quality of life, illness and death.

Trauma-informed care involves the recognition of the effects of trauma — among individual staff and collective systems — and how that trauma can affect the individuals we serve. Through this approach, organizations and systems of care work to cultivate physical environments that are healing and soothing, provide early screening and assessment, nurture a trauma-informed and responsive workforce, support workforce who are experiencing vicarious trauma, and utilize evidence-based and emerging best practices to address and treat trauma.

It will take a village for us to play offense against mental illness and addiction, breaking behavioral health out of the four walls of the specialty behavioral health clinic and infusing behavioral health into organizational culture and routine services of youth-serving organizations. SBIRT, Youth Mental Health First Aid and trauma-informed care are three concrete strategies to step up our game, because the stakes are far too high to just hold the line.

Jake Bowling, MSW, serves as assistant vice president, practice improvement for the National Council for Behavioral Health. In this role, he directs the Reducing Adolescent Substance Abuse Initiative and leads technical assistance for the Minority AIDS Initiative Continuum of Care grantees through the SAMHSA-HRSA Center for Integrated Health Solutions.

*Editor’s note: The Center for Sustainable Journalism, nonprofit publisher of Youth Today, has a grant from the Hilton Foundation to cover substance use disorder and prevention.

More related articles:

Jason’s Story

My Ongoing Battle with Substance Abuse

If They Had Asked: Young People in Recovery Reflect on What Could Have Been

  • George Patrin, MD

    Wonderful program, nice article of overview of the need and importance of establishing mental health in CHILDHOOD, for sure by the TEEN years. However, you emphasize “youth-serving organization” and totally ignore the two most important places where this program should be utilized – in Primary care clinics (with Family Practitioners and Pediatricians) and in schools (with teachers, nurses, and psychologists). Point of fact, this program needs to be given to all parents in their parenting classes, which I started at 9 months of age for all parents, not waiting until abuse or neglect occurred before ‘forcing’ them to attend. You will improve adoption of this program if you would stop thinking the prevention occurs in ‘specialty’ organizations instead of ‘primary prevention’ locations.