Change Package

What Is a Change Package?

Improving Adolescent Health: Facilitating Change for Excellence in SBIRT is a change package, or a practical guide that is specific enough for clinicians and practices to implement, test, and measure progress on an evidence-based set of changes while being generalizable enough to be scaled in multiple settings. Change packages are proven effectual tools to actuate practice transformation in primary care.

How to Use the Change Package

This change package outlines a framework for implementing adolescent SBIRT within primary care. The framework includes operational guidance for adopting foundational change management strategies to create optimal conditions for change, as well as clinical areas for action for SBIRT implementation. The change package comprises 11 specific recommendations – or change concepts – that marry high-level implementation guidance with the actual operational changes required for effective practice transformation. It also includes benchmarks as a way to measure implementation progress.

How Was This Change Package Tested?

To test the efficacy of the change package, the National Council, in partnership with Friends Research Institute and Aurora Research Institute, conducted an 18-month pilot program with 12 Federally Qualified Health Centers (FQHCs) from across the country. Sites received targeted, multi-modal and responsive training to implement SBIRT using the change package. Lessons from these sites are shared throughout the document as success stories and tips from pilot participants.

Change Package Companion Guides

In response to feedback from participants during the change package pilot phase, the National Council developed two companion guides: one guide tailored to providers seeking clinical guidance, and one to expand on the nuances of communicating for adolescent SBIRT engagement.

Provider Guide

This Provider Guide is an abbreviated version of the full change package. It serves as a reference for providers who work directly with adolescents providing SBIRT in a primary care setting seeking clinical guidance and easy access to tools. Thus, it presents a condensed version of the clinical areas of action for SBIRT delivery, and omits operational considerations such as policies, procedures and change management strategies. For comprehensive clinical and operational guidance, please refer to the full change package.

Communicating for Adolescent SBIRT Implementation Engagement Guide

Health care service settings are often hesitant or have concerns about change when implementing a new practice or protocol. Having the right tools to effectively communicate in these situations is critical to practice transformation success. The Communicating for Adolescent SBIRT Implementation Engagement Guide offers primary care agencies resources and tools for communicating the importance and impact of implementing SBIRT for adolescents. The guide includes answers to basic SBIRT questions and recommendations for how to communicate with a range of stakeholders for engagement.


Clinicians need a tool that can accurately assess the likelihood of a substance use disorder. The S2BI (Massachusetts Child Psychiatry Access Program, 2015) is one of several valid and reliable screening tools for substance use among youth (e.g., BSTAD [NIH], CRAFFT [SAMHSA]). The S2BI offers several advantages that make it ideal for use in many public health settings. Introduced in 2014 as a no-cost, validated instrument and recognized by both the American Academy of Pediatrics (AAP) and the Addiction Medicine Foundation (The Addiction Medicine Foundation, 2016). The S2BI:

  • Is quick and practical for short visits.
  • Effectively screens for alcohol, vapes, tobacco and marijuana (research indicates that if adolescents are not using one of the three, it is highly unlikely that they are using other substances [Woodcock et. al, 2015]).
  • Correlates with Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) diagnoses.
  • Although non-diagnostic, provides an accurate way to identify those who may have severe substance use disorders.
  • Provides results that can guide provider responses.

Copyright Acknowledgement

The S2BI is protected under a Creative Commons, Non-Commercial license, which means that it is free to use and distribute as long as you are 1) not using it for commercial purposes (making any profit off of your use) and 2) the following attribution is used: © Boston Children’s Hospital 2014. All rights reserved. This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.