GRANT NUMBER:  R01 AA016204-07S1

ABSTRACT:  This study examines how Screening, Brief Intervention and Referral to Treatment (SBIRT) can be costeffectively implemented in pediatric prif\lary care (PC) to improve early identification and treatment for AOD ~ problems among adolescents. It is a renewal of Screening for Youth Alcohol' and Drug Use: A Study of Primary Care Providers (R01 AA 16204), and extends the scope ofthe original project by testing a set of interventions. AOD prol::)lems can be devastating in youth; and early detection and intervention could make a critical difference.1-3 P,ediatric Primary Care Providers (PCPs) areideally placed to identify AOD problems before they become more serious. However, health systems have not implemented SBIRT for adolescents- -despite studies demonstrating effectiveness (although the. research on SHIRT in medicalsettings for . adolescents is less extensive/than for adults)~' and the cost-effectiveness of SBiRT is yet to be unequivocally esta.blished.4 We examine 1critical issues for adolescent health care such as hoW to detect problems and intervene effectively• and with cost efficiency, in waysthat are easily adaptable. The parent SBIRT grant Was based on our original survey of facilitators and barriers to AOD screening in PC, incorporating the survey's findings on the role of PCP characteristics (attitudes and knowledge about screening), environmental influences (mental health parity arid medical marijuana legislation), patient medical and psychiatric comorbidity, and service use patterns on screening. Based on those results the study has randdmized PCPs in a large medical center to one of three arms _Ia Usual Care arm and t\o\fo alternative modes of delivering SBIRT: 1) by PCPs, and 2) by Behavioral Medicine Specialists (BMSs). We trained PCPs and the BMSs In the same empirically-supported"SBIRT protocol. We compare SBIRT implementation, effectiveness, costeffectiveness and AOD outcomes in the .two intervention arms and the Usual Oare aim, Recent research has found non-PCPs effective indeliveringl screening and brief intervention, both to adults5-9 and adolescents.1 0-19 To our knowledge, no previous studies have compared the effectiveness of SBIRT delivered by PCPs to non:..PCP providers such as BMSs in PC. Our use of the electronic medical record (EMR) is innovative as a clinical tool1or promoting SBIRT and as an application for research. Findings will enable clinicians, health systems, <;md policy makers to determine the highest impact and most cost-effective models for' addressing AOD in pediatric PC. Asignificant element is its1timeliness; Kaiser is a laboratory , which allows us to study recent health refo,rm changes (e.g., integration of AOD treatment into PC), while controlling factors such as insurance, in a real-world clinical setting.


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