Grow With Grit: A School Nurse-Led SBIRT Pilot for Early Anxiety Detection

Inclusion Criteria:

1. GFPS students aged 8-12 years and enrolled at one of the following schools:

   Mountain View Elementary West Elementary Longfellow Elementary Sunnyside Elementary School
2. Participants will be identified through a weekly review of school nurse electronic health records (Frontline EHR) and attendance logs, and will include students who have either:

   1. Three or more nurse visits for somatic complaints within the past 6 weeks. For this study, somatic complaints are defined as the following physical symptoms that are not otherwise linked to exclusionary illness or chronic medical processes: stomach aches, headaches, fatigue, \& generalized muscle aches.
   2. Absenteeism greater than or equal to 10% of total school days due to the previously defined somatic complaints, within the past 6 weeks.
   3. English-speaking without an interpreter (both student and guardian).

Exclusion Criteria

1. Currently receiving ongoing behavioral health services, including psychotherapy, psychiatric medication management, or active behavioral health case management.

   1. Brief, one-time crisis counseling is not considered ongoing services.
   2. Questions about eligibility should be directed to the Principal Investigator.
2. Presence of a chronic medical diagnosis that fully accounts for the student's repeated somatic visits (e.g., asthma with frequent exacerbations, epilepsy, diabetes, sickle cell disease, or active cancer treatment).

   a. Students with partially explained symptoms who are also suspected to have co-occurring anxiety may be reviewed on a case-by-case basis by the PI/designee.
3. Documented cognitive or communication impairments that preclude meaningful completion of the SCARED screening tool or informed assent.

   1. Examples include moderate to severe intellectual disability or severe receptive/expressive language disorder without feasible accommodations.
   2. Students with an IEP or 504 plan that includes communication supports may be included if they can complete the tool with reasonable accommodations.
4. Students who are wards of the state or in foster care.
5. Non-English speaking students or guardians.
6. Acute safety concerns at the time of screening (e.g., active suicidal ideation with plan/intent, recent suicide attempt, or other crisis requiring immediate intervention).

   1. Such students will be triaged to crisis protocols and excluded from study participation at that time.