Trial of Automated Risk Appraisal for Adolescents

描述（由申请人提供）： 在美国，12-25岁的年轻人中问题药物使用、滥用和相关健康问题的流行病继续有增无减，部分原因是错过了早期识别和监测的机会。特别是，提高认识，并不断接触，问题药物的使用和滥用，青少年前和青少年在初级保健环境中可以提供重要的信息，卫生保健专业人员和从事早期干预服务。不幸的是，在初级保健环境中进行常规筛查和监测存在许多障碍。这些包括传统纸笔筛查的费用，对初级保健临床医生和办公室工作人员的竞争需求，复杂的评分程序以及随着时间的推移跟踪青年的能力。我们的目标是通过早期识别和监测的研究，改善基层医疗环境中青少年使用和滥用问题药物以及其他相关健康风险行为的服务。我们扩大了哥伦布儿童医院、家庭初级保健中心和Flipsidemedia.com之间的创新伙伴关系，以测试早期识别和监测系统的有效性和可接受性，该系统用于在一项随机试验中对青少年和青少年中的问题药物使用和滥用、抑郁症和相关精神障碍进行监测。我们建议比较护理在九个离家近的中心与自动风险评估青少年/电话支持（RA/TS）相比，常规护理加邮寄筛选结果（UC+）。每家研究中心将被随机分配开始接受6个月RA/TS治疗或6个月UC+治疗，随后接受替代治疗。RA/TS是一个基于网络的筛查和评估工具，由青少年在初级保健访问期间完成，以及一个有联系的结构化电话跟踪干预措施，包括给青少年及其家庭打三个后续电话，监测已查明的问题和服务障碍。具体而言，我们的目标是1）比较RA/TS青年与UC+青年中问题药物使用和滥用识别的频率; 2）检查RA/TS青年与UC+青年中问题药物使用和滥用筛查阳性的青年的咨询，转诊，精神药物或其他干预措施的频率。以及3）评估TS计划对恢复初级保健、完成转诊的可能性、初级保健就诊次数、专科就诊次数以及4个月后对服务的满意度的影响。

DESCRIPTION (provided by applicant): The pandemic of problem drug use, abuse and related health problems among young persons aged 12-25 in the U.S. continues unabated, in part, because opportunities for early identification and monitoring are missed. In particular, improved recognition of, and ongoing contact for, problem drug use and abuse among pre-teens and early adolescents in primary care settings could provide important information to health care professionals and engage early intervention services. Unfortunately, many barriers exist to routine screening and monitoring in primary care settings. These include the expense of traditional paper and pencil screening, competing demands on primary care clinicians and office staff, complex scoring programs and the ability to track youth over time. Our goal is to improve services for problem drug use and abuse and other related health risking behaviors for youth in primary care settings through research on early identification and monitoring. We expand an innovative partnership among the Columbus Children's Hospital, the Close To Home Primary Care Centers and Flipsidemedia.com to test the efficacy and acceptability of an early identification and monitoring system for problem drug use and abuse, depression and related mental disorders among pre-teens and teenagers in a randomized trial. We propose to compare care in nine Close To Home Centers with Automated Risk Assessment for Adolescents/Telephone Support (RA/TS) compared to usual care plus mailed screening results (UC+). Each site will be randomly assigned to start with six months on RA/TS or six months on UC+ and follow with the alternative. RA/TS is a web-based screening and assessment tool completed by adolescents during primary care visits and a linked, structured telephone tracking intervention consisting of three follow-up telephone calls to youth and their families monitoring identified problems and barriers to services. Specifically, we aim to 1) compare frequency of problem drug use and abuse identification in RA/TS youth vs. youth in UC+; 2) examine frequency of counseling, referral, psychotropic medication or other interventions for youth screening positive for problem drug use and abuse on RA in RA/TS youth vs. UC+ youth; and 3) evaluate the effect of the TS program on return to primary care, likelihood of completing referrals, number of primary care visits, number of specialty visits, and satisfaction with services after four months.