SBIRT Procedure

Enacted in March 2016, H. 4056, An Act relative to substance use, treatment, education and prevention, commonly called the “STEP Act,” aims to reduce risk of harm from substance use in adolescents by conducting verbal screenings and providing education around the risks related to substance use. The goals in screening students for use of alcohol and drugs are to provide for early identification and prevention of risk of harm from substance use. Achieving these goals requires the collaboration of parents/guardians, local health care providers, students, school nurses and counselors, and other members of the school staff and administration.

The Adolescent Screening, Brief Intervention, and Referral to Treatment (SBIRT) focuses on prevention, early detection, risk assessment, brief counseling and, when needed, referral. Use of a validated screening tool will enable school counselors and health professionals to detect risk for alcohol and drug use and related harm, and to address them at an early stage in adolescents. SBIRT may also alert school staff to students who may need attention for other risky behaviors and related mental health concerns.

For this purpose, the Melrose Public Schools uses the verbal substance use screening tool (CRAFFT II), which has been selected by the Massachusetts Department of Public Health (MDPH) and the Department of Elementary and Secondary Education (DESE).  The CRAFFT II is empirically based and developed through primary research (Knight 2002; Levy, et al, 2004).

Student privacy during the screening process will be carefully protected. Screening will be performed in locations where student privacy can be assured. Locations where conversations can be heard (i.e., behind a privacy screen) are inappropriate for conducting this screening and can violate a student’s right to privacy.

To protect student privacy and confidentiality, no names will be recorded on any of the screening or data collection tools. Further information on protecting confidentiality is detailed in the Data Collection and Confidentiality section below.

Parental/Guardian Notification and Opt Out Rights

Parents will be informed about the plan to conduct this screening prior to the start of the school year and will be provided a copy of the CRAFFT II.

Parents should be informed that verbal substance use screening is part of the school’s routine health screenings for its students, and that the screening is universal for all students in the selected population; students are not "pre-selected" for this screening.

A pupil or the pupil’s parent or guardian may opt out of the screening by providing written notification at any time prior to or during the screening.  The district will make available opt out forms for this purpose.

Data Collection and Confidentiality

Schools must ensure that student responses to verbal substance use screens are kept in confidence. Results of the screen may not be shared by screening team members to any other person in any form, including verbally, in writing, or in electronic form.

Basic demographic data, screening results, and interventions shall be collected and reported to MDPH within 90 days of completion of the screening.

No identifying data is to be collected or recorded on any student. Student names must not be recorded on any data collection or screening tool.

Under M.G.L. Chapter 71, Section 97, information disclosed by students during verbal substance use screening is confidential and may not be disclosed without prior written consent of the pupil and his/her parent or guardian unless there is an immediate medical emergency. In addition, no record in any form shall be made that includes information identifying the student.

Screening Procedures

School professionals involved in screening students using the verbal substance use tool must be properly trained in its use and carefully adhere to screening guidelines. Fidelity to the screening protocol must be maintained.  

All members of the screening team must attend an MDPH approved training session before screening any students for substance use. 

Melrose Public Schools will screen students in grades 8 and 10 by December 1 of each year.  The screening schedule should plan for sufficient staff to be available to conduct the screening efficiently and perform referrals as needed.

Screening sessions with students should not be rushed and team members will have time to meet after screenings are completed.

Referrals and Follow-up

Students who screen positive are referred to in-school or outside resources for further assessment, follow-up, and treatment as needed. In school, services may be provided by behavioral health professionals such as an adjustment counselor, school psychologist, or substance abuse counselor. Some students may require more intensive therapies or substance use services that can be provided by school health professionals. In these rare circumstances, out of school referrals may be indicated.

If a referral is required, this should be completed the same day as the screening. Students who require a referral for further assessment and evaluation should be monitored with a follow-up within no more than two weeks from the time of referral.

The decision to refer students for outside services should be based on the clinician’s assessment of a student’s risk of harm that is consistent with parameters typically used within the district.  It is recommended that two SBIRT team members (i.e., the nurse and a mental health professional) consult with each other prior to making a decision to break a student’s confidentiality.


Before disclosing the results of a verbal substance use screen to anyone, written consent must be obtained from the student. Parents or guardians must also consent in writing to allow the disclosure of this confidential information to outside providers. An MDPH approved consent form must be used (M.G.L. Chapter71, Section 97 (c)).

September 2017