Background Pediatricians underestimate the prevalence of substance misuse among children and adolescents and often fail to screen for and intervene in practice. The American Academy of Pediatrics recommends training in Screening, Brief Intervention, and Referral to Treatment (SBIRT), but training outcomes and skill acquisition are rarely assessed. Objective We compared the effects of online versus in-person SBIRT training on pediatrics residents' knowledge, attitudes, behaviors, and skills. Methods Forty pediatrics residents were randomized to receive either online or in-person training. Skills were assessed by pre- and posttraining standardized patient interviews that were coded for SBIRT-adherent and -nonadherent behaviors and global skills by 2 trained coders. Thirty-two residents also completed pre- and postsurveys of their substance use knowledge, attitudes, and behaviors (KABs). Two-way repeated measures multivariate analyses of variance (MANOVAs) and analyses of variance (ANOVAs) estimates were used to assess group differences in skill acquisition and KABs. Results Findings indicated that both groups demonstrated skill improvement from pre- to postassessment. Results indicated that both groups increased their knowledge, self-reported behaviors, confidence, and readiness with no significant between-group differences. Follow-up univariate analyses indicated that, while both groups increased their SBIRT-adherent skills, the online training group displayed more “undesirable” behaviors posttraining. Conclusions The current study indicates that brief training, online or in-person, can increase pediatrics residents' SBIRT skills, knowledge, self-reported behaviors, confidence, and readiness. The findings further indicate that in-person training may have incremental benefit in teaching residents what not to do.
Chronic pain is a common problem that can be challenging to treat because of its complex history, unclear etiology, and poor response to traditional treatment approaches. A growing body of research suggests that behavioral activation (BA), which was originally developed as a treatment for depression, may be a promising treatment for chronic pain. BA involves the identification and enactment of activities that are reinforcing to the individual and consistent with his or her long-term goals. The application of BA for the treatment of chronic pain is fully consistent with models of chronic pain which post that fear and avoidance leads to a cycle of physical deconditioning, increased pain as a result of deconditioning, lack of positive reinforcement, and low mood, and further reduced motivation to physically engage. The present paper will detail the assessment and use of BA to treat "Veteran," a patient with low back and bilateral foot pain. This case study highlights how gradually increasing engagement in previously avoided activities can help disrupt the harmful cycle among pain, fear and avoidance, and mood. The implication of the outcomes from this case study for future psychotherapy research on chronic pain is also discussed. (PsycINFO Database Record
The purpose of this article is to provide a data-driven exploration of an interdisciplinary pain rehabilitation program (PRP) as a viable option for addressing the dual crises of chronic pain and opioid use. Psychologists are crucial providers in the PRP, in both intervention and leadership roles. There is well-established literature supporting pain rehabilitation as an effective treatment for chronic pain and functioning, but there are few studies examining the effects of pain rehabilitation on opioid misuse risk. We evaluated data from 60 patients with diverse chronic pain conditions who completed an interdisciplinary PRP to evaluate changes in pain, functioning (self-report and objective physical measure), psychological symptoms, and health-related quality of life. To evaluate the effect of pain rehabilitation on opioidrelated risks, we examined opioid use and opioid misuse behaviors (measured by the Current Opioid Misuse Measure; COMM) pre-and posttreatment. Results demonstrated statistically significant improvements in all outcomes, with medium effect sizes for pain severity and large effect sizes for functioning, psychological symptoms, and emotional quality of life. Fifty-eight percent of patients were on opioid medications at entry compared with 15% at discharge. Among patients who entered on opioids, mean COMM scores were significantly reduced from above the cutoff for misuse risk (M ϭ 13.57) to below the cutoff (M ϭ 5.86). Overall, this study provided strong support for pain rehabilitation as an effective treatment for chronic pain and related suffering, while also providing a prevention-based opportunity for reducing opioid-related risk. Public Significance StatementThis study supports the dual power of multidisciplinary pain rehabilitation as a viable intervention to address the dual crises of chronic pain and opioid-related risks. Additionally, it highlights the key role of health psychologists on pain rehabilitation teams.
Screening, brief intervention, and referral to treatment (SBIRT) has become an empirically supported and widely implemented approach in primary and specialty care for addressing substance misuse. Accordingly, training of providers in SBIRT has increased exponentially in recent years. However, the quality and fidelity of training programs and subsequent interventions are largely unknown because of the lack of SBIRT-specific evaluation tools. The purpose of this study was to create a coding scale to assess quality and fidelity of SBIRT interactions addressing alcohol, tobacco, illicit drugs, and prescription medication misuse. The scale was developed to evaluate performance in an SBIRT residency training program. Scale development was based on training protocol and competencies with consultation from Motivational Interviewing coding experts. Trained medical residents practiced SBIRT with standardized patients during 10- to 15-min videotaped interactions. This study included 25 tapes from the Family Medicine program coded by 3 unique coder pairs with varying levels of coding experience. Interrater reliability was assessed for overall scale components and individual items via intraclass correlation coefficients. Coder pair-specific reliability was also assessed. Interrater reliability was excellent overall for the scale components (>.85) and nearly all items. Reliability was higher for more experienced coders, though still adequate for the trained coder pair. Descriptive data demonstrated a broad range of adherence and skills. Subscale correlations supported concurrent and discriminant validity. Data provide evidence that the MD3 SBIRT Coding Scale is a psychometrically reliable coding system for evaluating SBIRT interactions and can be used to evaluate implementation skills for fidelity, training, assessment, and research. Recommendations for refinement and further testing of the measure are discussed. (PsycINFO Database Record
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