This is a renewal of """"""""Screening for Youth AOD Use: A Study of Primary Care Providers. Health systems have not implemented Screening, Brief Intervention and Referral to Treatment (SBIRT) for adolescents despite research demonstrating its effectiveness. Based on prior research that identified barriers to AOD screening for adolescents in pediatric Primary Care (PC) and a pilot study that found SBIRT was feasible, well-received and promoted referrals to and initiation of specialty treatment, the current research application proposes to randomize Primary Care Physicians (PCPs) in the pediatrics clinic of a medical center within a large, managed care health system, Kaiser Permanente Northern California, to three arms - 1) Usual Care;2) SBIRT delivered by PCPs;and 3) SBIRT delivered by Behavioral Medicine Specialists (BMS). The study objective is to compare the implementation, effectiveness and cost-effectiveness of SBIRT for adolescents in PC in the three study arms. Patients will complete evidence-based screening and AOD assessment measures which have been embedded in the health plan's electronic medical record (EMR). A mixed model will be used to compare implementation outcomes (rates of screening and identification, brief intervention, referral to Chemical Dependency treatment and treatment initiaion), and effectiveness (patient outcomes of AOD use and abstinence) at 12 months. The model accounts for the intra-class correlations across patients within providers. Cost-effectiveness relative to implementation and patient outcomes will be examined. Barriers and facilitators of implementation, and feasibility via qualitative interviews with clinicians and administrators will be examined as well. The study is significant in that it examines issues that must be addressed to spur widespread adaptation of SBIRT. The proposed intereventions are highly feasible in the current environment of health reform due to increased resources and training to Federally Qualified Health Centers and private health plans. It is innovative in using the EMR to change clinical practice and systematically integrate AOD in PC, and as a platform for collecting research data.

Public Health Relevance

AOD problems are prevalent and devastating for adolescents, as well as costly to society, and early detection and intervention can make a critical difference. We study how to identify and intervene effectively and economically in ways that are widely adaptable. The study provides critical information for health systems and clinicians to mainstream AOD services in primary care and has implications for the development of medical home concepts for the AOD field.

National Institute of Health (NIH)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Research Project (R01)
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Health Services Research Review Subcommittee (AA)
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Roach, Deidra
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University of California San Francisco
Schools of Medicine
San Francisco
United States
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Sterling, Stacy; Kline-Simon, Andrea H; Weisner, Constance et al. (2018) Pediatrician and Behavioral Clinician-Delivered Screening, Brief Intervention and Referral to Treatment: Substance Use and Depression Outcomes. J Adolesc Health 62:390-396
Kline-Simon, Andrea H; Litten, Raye Z; Weisner, Constance M et al. (2017) Posttreatment Low-Risk Drinking as a Predictor of Future Drinking and Problem Outcomes Among Individuals with Alcohol Use Disorders: A 9-Year Follow-Up. Alcohol Clin Exp Res 41:653-658
Sterling, Stacy; Kline-Simon, Andrea H; Jones, Ashley et al. (2017) Specialty addiction and psychiatry treatment initiation and engagement: Results from an SBIRT randomized trial in pediatrics. J Subst Abuse Treat 82:48-54
Sterling, Stacy; Kline-Simon, Andrea H; Satre, Derek D et al. (2015) Implementation of Screening, Brief Intervention, and Referral to Treatment for Adolescents in Pediatric Primary Care: A Cluster Randomized Trial. JAMA Pediatr 169:e153145
Satre, Derek D; Delucchi, Kevin; Lichtmacher, Jonathan et al. (2013) Motivational interviewing to reduce hazardous drinking and drug use among depression patients. J Subst Abuse Treat 44:323-9
Sterling, Stacy; Valkanoff, Tina; Hinman, Agatha et al. (2012) Integrating substance use treatment into adolescent health care. Curr Psychiatry Rep 14:453-61
Sterling, Stacy; Kline-Simon, Andrea H; Wibbelsman, Charles et al. (2012) Screening for adolescent alcohol and drug use in pediatric health-care settings: predictors and implications for practice and policy. Addict Sci Clin Pract 7:13
Sterling, Stacy; Weisner, Constance; Hinman, Agatha et al. (2010) Access to treatment for adolescents with substance use and co-occurring disorders: challenges and opportunities. J Am Acad Child Adolesc Psychiatry 49:637-46; quiz 725-6