Karen Siska-Creel, Anne Arundel County’s school health and support director, knows from experience that if a problem pops up in the community, it won’t take long for it to appear in schools.
When the opioid epidemic began to spread in Anne Arundel County around 2016, Siska-Creel saw local fire departments establish pop-up stations to help people suffering from addiction. But it wasn’t until a high schooler pleaded with school nurses and the health department for help with their addiction that she realized the depth of need in the public school system.
“The nurse tried and tried and tried — so did the school counselor — tried to plug this student into services. And we couldn’t do it,” Siska-Creel said. “The child left, was very upset, left, didn’t show up for two weeks, and had died of an overdose.”
Within the next year, Siska-Creel helped create the Screening Teens to Access Recovery Program in Anne Arundel County Public Schools. Called the STAR program, it’s a partnership with the county Department of Health that allows school nurses to pair middle and high schoolers with substance abuse treatment services. Siska-Creel said since its inception, about 50 students have been referred to services.
For Ryan Voegtlin, the assistant superintendent of student services at Anne Arundel County Public Schools, the program was born from a “gap in service” in substance abuse treatment for youth.
“It’s no like we have hundreds of kids coming to access screening through the STAR Program every year,” Voegtlin said. “But it is an opportunity for them to get a screening and to get pointed in the right direction.”
How it works
About a day after the STAR Program’s launch was announced, Siska-Creel said, a student walked into their school’s nurse’s office with a paper in hand.
“‘My dad said to either get help or don’t come home,’” Siska-Creel recalls the student saying.
The youngster, who went to their nurse’s office, was then given an iPad in a private room, where they were connected to a licensed therapist and asked questions about their possible addiction or mental health struggles. The same process is used for any student in the program, Siska-Creel said.
From there, the student will then receive a list of services, said Darin Ford, the program manager of the adolescents and family services division in the health department.
The STAR Program also requires a student’s consent for their parents or guardians to be told about them seeking services, Ford said.
“It really creates a safe space for teens, for youth, to feel like they don’t have to worry about what others might be thinking about them. It’s all protected,” Ford said. “It’s really, especially during this day in age, for teens to know if they’re dealing with substance use or substance misuse, that there’s a safe space for them to go to get the help that they need.”
The health department will check in with a student who sought services a week after their screening to see if they contacted the resources or needed any others, Ford added. This way, the program provides treatment that lets students come when they need it — a strategy highly recommended when treating substance abuse, according to Jen Corbin, the director of Anne Arundel County’s crisis response.
Continuing to push students to receive treatment could be read as applying too much pressure, Ford said.
The strategy — scientifically recognized as the Screening, Brief Intervention and Referral to Treatment approach — is widely used to identify people who might show symptoms of addiction or possibility of developing an addiction in the future, according to the National Institute of Health.
It’s mainly used for youth and is expanding beyond doctors’ offices, an approach that studies in the Journal of Adolescent Health evaluated to be highly effective, especially once they’re added to schools.
“When you ask the question, ‘What was the age that you first used the substance? What substance was it?’ Most of the gateway stuff was, ‘I used at 13, 14, 15,’” Corbin said of her screenings at Safe Stations, a program that she helped start that hosts mental health and substance abuse screenings in the county’s police and fire stations. “The conversation grew to, do we need to go back to making sure we’re educating our kids?”
Origin and limitations
Under the STAR Program, school nurses’ offices act as the safe stations where students can be connected to treatment, Corbin said..
“When someone comes walking in, they’re more likely to grab the hand of the person out and say ‘Hey, I’m ready to get help,’ versus if I go to you and say ‘Hey, you overdosed, would you like help?’” Corbin said. “They may not be ready, they may not even want to talk to you, they may deny overdosing.”
Other school systems, such as in King County, Washington state, have somewhat different programs. There, the Snoqualmie Valley School District administers screenings to all middle school students.
Families are also able to withdraw their students from taking the screening, according to the district’s website. The same goes for some state-mandated programs, such as one established in Massachusetts in 2016.
But Anne Arundel County Public Schools are taking a different approach: one that relies on students to seek help.
“There’s a balance in really respecting the student, just like you would respect an adult,” Ford said. “It’s really client-centered and motivated, versus directive.”
Down to the numbers
Researchers discovered that programs such as STAR are generally effective. In a Journal of Adolescent Health study conducted in 2022, researchers discussed student-based programs like STAR with 26 students in middle school — or grades six to eight — who had received screenings and interventions. The surveyed students overwhelmingly said they were satisfied with the approach, the study found.
Sharon Reif, a faculty member at Brandeis University’s Heller School for Social Policy and Management in Massachusetts and lead author of another 2022 paper in the Journal of Adolescent Health, found that screening and intervention services such as the STAR Program are typically low cost.
But her study also acknowledged the costs of these programs are generally unknown past being integrated into schools that can receive state or federal grant funding.
“The issue is when you’re outside of those healthcare settings, insurance tends to actually say, ‘No, we’re not going to pay for things that are out there,’ even if they’re sort of healthcare,” Reif said. “And if you want to get kids, if you want to get youth, the healthcare setting is not the best place to get them, because they’re not there that often in the way that older people are.”
The implementation cost also depends on who conducts the screenings, Reif added. Having a doctor screen students is typically more expensive than having a school nurse or other aide do it, Reif said.
“Having a doctor do something is very expensive, having a nurse is less expensive, having a PA or an aide is less expensive,” Reif said. “So it partly gets to that in terms of, how do you pay for it, and whose time is the most valuable?”
Safe Stations is predominantly funded by grants from the Anne Arundel County Health Department, Corbin said. The STAR Program is also primarily funded by the department, as well as Anne Arundel County Public Schools for its middle school portion.
A 2024 Maryland Community Health Resources Commission showed more than $6 million in grants allocated toward the Anne Arundel County Department of Health for Thrive Behavioral Health, one of the contracting services that conducts screenings for middle schoolers, along with other substance abuse grants.
“It’s just continuing in getting the word out and figuring out where those gaps are and offering services,” Voegtlin said. “Definitely scouring for grants where we can find grants that meet our needs. That’s the name of the game right now.”
Anne Arundel County has continued to increase funding for its Health Department. Its budget has increased by nearly 23% since fiscal 2023, according to county budget documents.
Moving forward
About 48.5 million people suffered from a substance abuse disorder in 2023, according to a survey conducted by the Substance Abuse and Mental Health Service Administration in the U.S. Department of Health and Human Services.
But of that amount, just about 7.1 million people received treatment.
The state’s Youth Risk Behavior Survey does not track addiction, but it does study drug use by Maryland high school students. The latest survey, from the 2022-23 school year, showed 11.1% of high school students statewide had used prescription opioids without a prescription. That’s down from 15.2% 10 years earlier, but drug abuse continues to be a grave concern for those who work with teens.
For Voegtlin, ensuring students know where the services are is most important for the program to grow, while also protecting students’ autonomy in the process.
“It’s just kind of this balance,” Voegtlin said. “We want kids to come, but don’t want them to feel stigmatized about going there, right?”
As struggles with substance abuse evolve, Siska-Creel said she’s not sure where the STAR Program will grow, either. She focuses on the community to tell next steps about the program, she added.
“It’s really what’s ever going on in the community,” Siska-Creel said. “I’ll see it in the schools. It eventually comes in.”