Lessons in Implementation from a 5-Year SBIRT Effort Using a Mixed-Methods Approach

Evans, Brooke; Kamon, Jody; Turner, Win C

doi:10.1007/s11414-023-09835-6

Cited by 3 publications

(1 citation statement)

References 56 publications

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“…All site staff (eg, physicians, nurse practitioners, and behavioral specialists) who provide BI and RT services to adolescents are eligible to provide SBIRT-A services as part of this trial. Physicians in leadership roles at each site (eg, the medical director) will serve as site champions to pioneer the implementation of site-based study procedures and promote acceptance and buy-in among all site staff [ 50 ]. Each site will receive performance feedback (eg, the uptake of SBIRT procedures and progress toward patient enrollment goals) and participate in cross-site monthly learning collaboratives to discuss and problem-solve implementation barriers and facilitators.…”

Section: Methodsmentioning

confidence: 99%

Standard Versus Family-Based Screening, Brief Intervention, and Referral to Treatment for Adolescent Substance Use in Primary Care: Protocol for a Multisite Randomized Effectiveness Trial

Hogue,

Porter,

Ozechowski

et al. 2024

JMIR Res Protoc

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Background Screening, brief intervention, and referral to treatment for adolescents (SBIRT-A) is widely recommended to promote detection and early intervention for alcohol and other drug (AOD) use in pediatric primary care. Existing SBIRT-A procedures rely almost exclusively on adolescents alone, despite the recognition of caregivers as critical protective factors in adolescent development and AOD use. Moreover, controlled SBIRT-A studies conducted in primary care have yielded inconsistent findings about implementation feasibility and effects on AOD outcomes and overall developmental functioning. There is urgent need to investigate the value of systematically incorporating caregivers in SBIRT-A procedures. Objective This randomized effectiveness trial will advance research and scope on SBIRT-A in primary care by conducting a head-to-head test of 2 conceptually grounded, evidence-informed approaches: a standard adolescent-only approach (SBIRT-A-Standard) versus a more expansive family-based approach (SBIRT-A-Family). The SBIRT-A-Family approach enhances the procedures of the SBIRT-A-Standard approach by screening for AOD risk with both adolescents and caregivers; leveraging multidomain, multireporter AOD risk and protection data to inform case identification and risk categorization; and directly involving caregivers in brief intervention and referral to treatment activities. Methods The study will include 2300 adolescents (aged 12-17 y) and their caregivers attending 1 of 3 hospital-affiliated pediatric settings serving diverse patient populations in major urban areas. Study recruitment, screening, randomization, and all SBIRT-A activities will occur during a single pediatric visit. SBIRT-A procedures will be delivered digitally on handheld tablets using patient-facing and provider-facing programming. Primary outcomes (AOD use, co-occurring behavior problems, and parent-adolescent communication about AOD use) and secondary outcomes (adolescent quality of life, adolescent risk factors, and therapy attendance) will be assessed at screening and initial assessment and 3-, 6-, 9-, and 12-month follow-ups. The study is well powered to conduct all planned main and moderator (age, sex, race, ethnicity, and youth AOD risk status) analyses. Results This study will be conducted over a 5-year period. Provider training was initiated in year 1 (December 2023). Participant recruitment and follow-up data collection began in year 2 (March 2024). We expect the results from this study to be published in early 2027. Conclusions SBIRT-A is widely endorsed but currently underused in pediatric primary care settings, and questions remain about optimal approaches and overall effectiveness. In particular, referral to treatment procedures in primary care remains virtually untested among youth. In addition, whereas research strongly supports involving families in interventions for adolescent AOD, SBIRT-A effectiveness trial testing approaches that actively engage family members in primary care are absent. This trial is designed to help fill these research gaps to inform the critical health decision of whether and how to include caregivers in SBIRT-A activities conducted in pediatric primary care. Trial Registration ClinicalTrials.gov NCT05964010; https://www.clinicaltrials.gov/study/NCT05964010 International Registered Report Identifier (IRRID) PRR1-10.2196/54486

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Section: Methodsmentioning

confidence: 99%

Standard Versus Family-Based Screening, Brief Intervention, and Referral to Treatment for Adolescent Substance Use in Primary Care: Protocol for a Multisite Randomized Effectiveness Trial

Hogue,

Porter,

Ozechowski

et al. 2024

JMIR Res Protoc

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Early Detection and Access to Care Will Keep the Pot from Boiling Over

Ingoglia¹

2023

J Behav Health Serv Res

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Standard Versus Family-Based Screening, Brief Intervention, and Referral to Treatment for Adolescent Substance Use in Primary Care: Protocol for a Multisite Randomized Effectiveness Trial (Preprint)

Hogue,

Porter,

Ozechowski

et al. 2023

Preprint

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UNSTRUCTURED Screening, brief intervention, and referral to treatment for adolescents (SBIRT-A) is widely recommended to promote detection and early intervention for alcohol and other drug (AOD) use in pediatric primary care. Existing SBIRT-A procedures rely almost exclusively on adolescents alone, despite recognition of caregivers as critical protective factors in adolescent development and AOD use. Moreover, controlled SBIRT-A studies conducted in primary care have yielded inconsistent findings about implementation feasibility and effects on AOD outcomes and overall developmental functioning. There is urgent need to investigate the value of systematically incorporating caregivers in SBIRT-A procedures. This randomized effectiveness trial compares a standard adolescent-only approach (SBIRT-A-Standard) versus a family-based approach (SBIRT-A-Family) in which caregivers are systematically included in SBIRT-A activities. The study includes N = 2,300 adolescents (age 12 – 17) and their caregivers attending one of three hospital-affiliated pediatric settings serving diverse patient populations in major urban areas. Study recruitment, screening, randomization, and all SBIRT-A activities occur during a single pediatric visit. SBIRT-A procedures are delivered digitally on hand-held tablets using patient-facing and provider-facing programming. Primary outcomes (AOD use, co-occurring behavior problems, parent-youth communication about AOD use) and secondary outcomes (adolescent quality of life, therapy attendance) are assessed at screen/initial and 3, 6, 9, and 12 months follow-up. The study is well powered to conduct all planned main and moderator (age, sex, race/ethnicity, youth AOD risk status) analyses. Trial results will inform the critical health decision of whether and how to include caregivers in SBIRT-A activities conducted in pediatric primary care.

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Lessons in Implementation from a 5-Year SBIRT Effort Using a Mixed-Methods Approach

Cited by 3 publications

References 56 publications

Standard Versus Family-Based Screening, Brief Intervention, and Referral to Treatment for Adolescent Substance Use in Primary Care: Protocol for a Multisite Randomized Effectiveness Trial

Standard Versus Family-Based Screening, Brief Intervention, and Referral to Treatment for Adolescent Substance Use in Primary Care: Protocol for a Multisite Randomized Effectiveness Trial

Early Detection and Access to Care Will Keep the Pot from Boiling Over

Standard Versus Family-Based Screening, Brief Intervention, and Referral to Treatment for Adolescent Substance Use in Primary Care: Protocol for a Multisite Randomized Effectiveness Trial (Preprint)

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