Across the United States, K-12 public schools are required to offer certain health services to their students. With Medicaid funding, not only can the quantity and quality of those services be augmented, but school-based health centers (SBHCs) can also offer services to children and adolescents who may not otherwise have access to care.
These services are not limited to just mental and physical care, but also include opportunities to help prevent substance abuse and misuse. Almost 21 million Americans have at least one alcohol- or drug-related addiction, and more than 90% of addictions begin before the age of 18. SBHCs have a unique opportunity to educate children and adolescents about substance abuse and misuse at a young age.
This is why the School-Based Health Alliance – a Modern Medicaid Alliance partner – developed the innovative Screening, Brief Intervention, Referral to Treatment (SBIRT) toolkit, an evidence-based resource to help health professionals effectively convey the importance of avoiding dangerous substances.
Medicaid Support for Schools
Medicaid funding is allocated both to support health professionals, such as school nurses, psychologists, and speech-language pathologists, and to deliver medical services to students.
SBHCs provide preventive care (e.g. immunizations), behavioral health care, routine health screenings, and more, ensuring that children and adolescents who are enrolled in Medicaid have access to the care they need.
In addition to the services from SBHCs, schools can receive Medicaid reimbursement for providing Early Periodic Screening Diagnostic and Treatment (EPSDT) services, such as hearing and dental screenings, and some districts use Medicaid to pay for specialized equipment, including for children and adolescents with special needs and disabilities.
Medicaid funding can help leverage SBHCs’ ability to deliver services under the Individuals with Disabilities Education Act (IDEA), which ensures that children and adolescents with disabilities are entitled to free public education tailored to meet their unique health needs (e.g., physical and speech therapy). IDEA faces a lack of adequate federal funding, and by allocating revenue through Medicaid, states and schools will not need to utilize general education dollars to offset costs associated with special education.
Medicaid funding further enables the integration of psychologists in school-based health care, allowing professionals to develop interventions for learning disabilities, help manage chronic conditions, and assist in the integration of children and adolescents with physical or mental disabilities — all of which can lead to greater academic success.
Addressing Adolescent Substance Use Through SBHCs
According to the National Survey of Drug Use and Health (NSDUH), 6.3% of people ages 12 to 17 (approximately 1.5 million individuals) have a substance use disorder. Further, 2.8% of individuals within the same age group have an alcohol use disorder.
Preventing future adolescent alcohol and substance abuse starts with education and resources being made available to and through school-based health professionals.
The Screening, Brief Intervention, Referral to Treatment (SBIRT) toolkit, developed by the School-Based Health Alliance, highlights five core components:
- Regular, de-stigmatized, and universal screening for substance use through validated tools;
- Consideration of substance use as a continuum rather than a dichotomous “addicted versus not addicted” judgment;
- Use of motivational interviewing-based, patient-centered talk versus directive, prescriptive talk;
- Broad understanding of “referral to treatment,” to include traditional treatment as well as support and anticipatory guidance for all levels of use or abstinence, including harm reduction methods when appropriate; and
- Facilitation of smooth, bidirectional transitions among primary care, behavioral health, and specialty addiction treatment when indicated.
Research has shown that adolescence is a critical time to prevent addiction later in life. Implementing the SBIRT model with adolescent patients can help delay initiation of use, increase motivation to abstain, and offer specialized treatment to adolescents experiencing a substance use disorder.
The SBIRT toolkit offers an integrative and collaborative SBHC model which teaches best practices to health professionals, including video demonstrations and explanations, step-by-step methods for effective communication which take situational differences into account, and even information on billing and reimbursement to ensure sustainable programs.
With Medicaid reimbursement, implementation of the SBIRT approach is not only attainable across schools but can also be leveraged to have an even greater impact on the future health of adolescent populations, no matter their background.