kids dancing

Credit: Ed Yourdon

Young people are creative–we should be, too. Learn about the Hilton Foundation’s flexible approach to SBIRT for youth.

If you want to get jazzed about substance use interventions for adolescents, I suggest you talk to Alexa Eggleston at the Conrad N. Hilton Foundation. She will jazz you right up.

Eggleston is the senior program officer of the Hilton Foundation’s five-year, $50 million Youth Substance Use Prevention and Early Intervention Initiative, which launched in the summer of 2013. For its first round of funding, the Initiative has targeted a terrific variety of systems that serve young people: juvenile justice settings, job skills programs, schools, and more.

And although the Hilton Foundation has funded drug and alcohol prevention for decades, this particular initiative is new. In 2012, the Foundation decided to step back and reconsider its approach to substance use. It wanted a new strategy based on “what’s new, what’s exciting, what’s innovative,” explained Eggleston.

The conclusion? Screening, Brief Intervention and Referral to Treatment (SBIRT) for youth between the ages of 15 and 22.

The compelling reason to target adolescents is the fact that we know addiction is very often a pediatric disorder. “For the vast majority of people, addiction and risky substance use begin in adolescence,” said Eggleston. “But there are things we can do make a difference. It’s not a lost cause.”

Before coming to the Hilton Foundation, Eggleston worked at several non-profit organizations focused on improving access to addiction services, including the Legal Action Center, where “I advocated a lot for treatment access, treatment quality, reducing the stigma of addiction.” But as she worked to mitigate addiction’s social, legal, and health consequences, it was only natural that she’d become interested in upstream solutions.

“I wanted to do something more prevention- and early intervention-focused,” she explained. “We’ve been missing the boat on this adolescent thing and it’s so frustrating…how do we work with young people? How do we not sit around and wait for them to get kicked out of college, to get arrested, to get addicted?”

The Hilton Foundation is going to help us find out.


SBIRT is a public health approach to reducing risky substance use. It’s a process that can be done virtually anywhere, but has often been implemented in medical settings.

sbirt model

A model of the SBIRT process

Studies have shown that SBIRT can reduce risky alcohol use among adults. The body of evidence for adolescents–although promising–is less-established.

Eggleston sees the Hilton Foundation Initiative as an opportunity to use SBIRT creatively to match the needs of young people.

“How do we tailor this SBIRT model for an adolescent population? Do young people hold doctors in the same esteem as adults do? Are kids as willing to disclose? Are peer-based approaches more effective? These are the kinds of questions it’s so interesting to be able to explore.”

“In no way are we trying to retrofit an adult model for an adolescent population.”

Based on the idea of bending SBIRT until it fits young people–and not the reverse–the Hilton Foundation has backed some very interesting projects. Among them:

SBIRT training for staff at a federal job skills and youth development program

Adapting and implementing SBIRT in five juvenile justice settings

Leveraging local foundation funding to expand SBIRT for youth in hospitals and clinics across New Hampshire

Training youth to do peer-based SBIRT

The Foundation is partnering with Abt Associates to evaluate the initiative’s impact with the intent that the results of these (and other) projects will contribute to the body of literature about early interventions for youth, which is one of the goals of the Hilton Foundation Initiative.

“If SBIRT for youth is not evidence-based now, how will we ever get there if we don’t invest in programs to learn?” Eggleston pointed out. “We’re very thoughtful in how we design programs. And we’ve got to start somewhere.”

The launch of the Hilton Foundation Initiative coincides with a surge of curiosity about adolescent brains–how they work, their effect on adolescent behavior, and how we can use this knowledge to tailor developmentally-appropriate health interventions.

A new book by Dr. Frances Jensen, The Teenage Brain, condenses recent research into a practical parenting guide. Regarding addiction, she told NPR: “Just like learning a fact is more efficient, sadly, addiction is more efficient in the adolescent brain. That is an important fact for an adolescent to know about themselves — that they can get addicted faster. It also is a way to debunk the myth, by the way, that, ‘Oh, teens are resilient, they’ll be fine. He can just go off and drink or do this or that. They’ll bounce back.’ Actually, it’s quite the contrary.”

Eggleston, too, said it’s time to extinguish those myths. “We need to combat messages like ‘It’s a rite of passage’ and ‘All kids use.’ Those are destructive messages.”

SBIRT, to Eggleston, is a way of equipping youth service providers with skills to address the issue of substance use, which she says is widely understood to be a factor in low achievement, criminal justice involvement, and health disparities. “But they [people who work with youth] have no idea what to do about it…There’s so much potential for us to become more proactive.”


I picked Eggleston’s brain about the Initiative for an hour and then asked who gets her stoked about these ideas, since her enthusiasm is so apparent. She said there are far too many to mention, and then offered this (partial) list of her personal SBIRT superstars.

Pediatrician Sharon Levy out of Boston Children’s Hospital has shown incredible leadership on this issue.

Psychiatrist Ken Winters, who leads the Center for Adolescent Substance Abuse Research at the University of Minnesota, has been doing great work in this area for years.

The folks at the Friends Research Institute are doing important fundamental research on youth SBIRT.

Filmmaker Greg Williams, who released The Anonymous People in 2013, is working on a second film about youth recovery and one of the underlying themes is that addiction is a pediatric disorder.


Join our SBIRT for Youth Learning Community – open to all!

Register for our free online course, SBIRT for Adolescents, led by Dr. Sharon Levy – CEUs are available!

Later this year, Alexa Eggleston will lead a webinar about the Hilton Foundation Initiative – stay tuned for information and registration!