Online System for Primary Care to Prevent and Address Teen Substance Use

预防和解决青少年药物滥用的初级保健在线系统

• 批准号: 10451691
• 负责人: Sion Kim Harris
• 金额: $ 44.18万
• 依托单位: TOTAL CHILD HEALTH, INC.
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10451691
• 关键词: Abstinence; Accidental Injury; Accreditation; Address; Adolescence; Adolescent Medicine; Alcohol consumption; American; Belief; Brain Injuries; Certification; Cessation of life; Child health care; Childhood; Clinical; Collection; Consensus; Contracts; Data; Development; Diagnosis; Drowning; Early Intervention; Education; Elements; Ethanol toxicity; Event; Family Practice; Feedback; Goals; Impaired cognition; Individual; Intervention; Intervention Trial; Interview; Life; Liver; Measures; Morbidity - disease rate; Online Systems; Outcome; Overdose; Parents; Patients; Pediatrics; Persons; Phase; Prevention education; Primary Health Care; Privatization; Process; Provider; Qi; Quality Control; Questionnaires; Randomized; Schedule; Screening Result; Social support; Substance abuse problem; Support System; System; Systems Integration; Teenagers; Testing; Time; Training; Transcript; Vehicle crash; Visit; addiction; adolescent substance use; behavior change; brief advice; care coordination; care providers; computerized; coping; cost; driving behavior; education resources; effectiveness evaluation; effectiveness testing; efficacy testing; emotion regulation; evidence base; follow-up; high risk sexual behavior; improved; innovation; intervention program; liver injury; lung injury; motivational enhancement therapy; pilot test; prevent; preventive intervention; programs; recruit; screening; screening and brief intervention; screening participation; social; substance use; substance use prevention; substance user; theories; treatment as usual; web site

Substance use usually (90%) begins during adolescence, causing brain and liver damage, risky sexual and driving behavior, and potentially leading to addiction therefore prevention and early intervention programs targeting teens are needed to prevent this morbidity, gain productive years of life and reduce costs. This proposal presents innovations to overcome the barriers to effectively addressing teen substance use during primary care visits through further development of a promising computerized alcohol and substance use computerized Screening and provider Brief Advice system (cSBA) and integration with an online “clinical process support system” called CHADIS. CHADIS addresses all pediatric screening needs and is currently widely used in pediatric practice making widespread dissemination of a CHADIS-cSBA module immediately feasible. However, because of limitations related to time and training the approach of motivational interviewing (MI), with strong evidence for effecting behavior change in substance users, was not a part of cSBA. An innovation proposed here will take pre-visit teen data related to strengths and goals and acknowledged reasons for usage to populate individualized “teleprompters” accessible at the moment of care by PCP’s along with options for sharing graphical representations for use in reinforcing abstinence or motivate discontinuing usage. In addition, the prompts for discussion of teen identified strengths and goals will include wording from teen studies using “incremental theory”(or the belief that people have the potential to change), which has shown result in improvements in social coping. CHADIS-cSBA will also provide each teen a confidential individualized portal automatically populated with supports for their endorsed strengths and other supports as well as substance-related follow-up messaging. Post-visit parent education will include access to a Teen Safe course. Teens found to have serious substance abuse or dual diagnoses will have referrals facilitated by care coordination functionality. PCP participation will be reinforced by a American Board of Pediatrics accredited quality improvement program for their required re-certification (MOC-4). In Phase 1, the CHADIS-cSBA module will be created with both professional and teen feedback and MOC-4 certification obtained. In Phase 2 the resulting system will be piloted; a baseline of substance use screening conducted; then CHADIS-cSBA module will be randomly assigned to doctors and a quality improvement intervention will be conducted to measure reduction in rates of any substance use at 3 and 12 month follow-up compared to treatment as usual.

物质使用通常（90%）在青春期开始，导致大脑和肝脏损伤、危险的性行为 和驾驶行为，并可能导致成瘾，因此要预防和早期 需要针对青少年的干预计划来预防这种发病率，赢得富有成效的岁月 生活并降低成本。 该提案提出了克服障碍的创新 通过进一步发展，有效解决青少年在初级保健就诊期间使用药物的问题 有前途的计算机化酒精和药物使用计算机化筛查和提供者简介 建议系统 (cSBA) 以及与名为“临床流程支持系统”的在线“临床流程支持系统”的集成 查迪斯。 CHADIS 可满足所有儿科筛查需求，目前广泛用于儿科 实践使广泛传播 CHADIS-cSBA 模块立即变得可行。 然而， 由于时间和培训动机访谈（MI）方法的限制， 具有影响物质使用者行为改变的有力证据，不属于 cSBA 的一部分。 一个 这里提出的创新将获取与优势和目标相关的访问前青少年数据， 承认使用填充目前可用的个性化“提词器”的原因 PCP 的护理以及共享图形表示以用于强化的选项 禁欲或促使停止使用。 此外，青少年讨论的提示 确定的优势和目标将包括使用“渐进理论”（或 相信人们有改变的潜力），这已显示出改善的结果 社会应对。 CHADIS-cSBA 还将为每个青少年提供一个保密的个性化门户 自动填充对其认可优势的支持和其他支持以及 与物质相关的后续消息传递。 访问后家长教育将包括接触青少年 安全课程。 被发现有严重药物滥用或双重诊断的青少年将得到转诊 护理协调功能促进了这一点。 美国将加强 PCP 的参与 儿科委员会认可质量改进计划，以满足其所需的重新认证 （MOC-4）。在第一阶段，CHADIS-cSBA 模块将由专业人士和青少年共同创建 反馈并获得 MOC-4 认证。 在第二阶段，最终的系统将进行试点；一个 进行物质使用筛查的基线；那么 CHADIS-cSBA 模块将被随机分配到 将进行医生和质量改进干预措施，以衡量死亡率的降低 与常规治疗相比，在 3 个月和 12 个月的随访中使用任何物质。

项目成果

High-Potency Cannabis Use in Adolescence.

青春期的高效大麻使用。

• DOI: 10.1016/j.jpeds.2022.07.034
• 发表时间: 2023
• 期刊: The Journal of pediatrics
• 作者: Vargas,Gabriela;Shrier,LydiaA;Chadi,Nicholas;Harris,SionK
• 通讯作者: Harris,SionK