SBIRT Implementation for Adolescents in Urban Federally Qualified Health Centers

描述（由申请人提供）：酒精、烟草和其他药物的使用在美国青少年中仍然非常普遍，对他们的福祉和公共卫生构成威胁。临床试验和荟萃分析证据支持筛选、短暂干预和转诊治疗（SBIRT）对青少年药物滥用的有效性，SBIRT是由美国儿科学会推荐的。尽管联邦政府支持SBIRT，但初级保健提供者在采用这种循证方法方面进展缓慢。因此，需要进行研究，以确定在青少年中实施SBIRT的有效方法，以便扩大这种方法的规模并实现其全面的公共卫生影响。在Proctor实施研究概念模型的指导下，本研究是一项多地点、集群随机试验，比较青少年医学中两种主要的SBIRT递送策略。在通才策略中，初级保健提供者提供药物滥用的简短干预（BI）。在专家策略中，BIs由行为健康咨询师提供。8个研究地点，由巴尔的摩一家大型城市联邦合格卫生中心运营的初级保健诊所，将随机分配使用通才或专家策略对青少年实施SBIRT。将对每个地点的工作人员进行指定实施战略的培训，并在实施期间每季度提供一次加强培训。实施结果，包括：普及率、成本/成本效益、可接受性、及时性、保真度/依从性和患者满意度，将在长达18个月的实施期间通过行政服务接触数据、提供者和患者调查以及定性访谈的互补组合进行评估。在积极执行期结束时，所有培训和技术支助活动将停止12个月，以便衡量相对的可持续性。具体目标是：

DESCRIPTION (provided by applicant): Alcohol, tobacco, and other drug use remains highly prevalent among US adolescents and is a threat to their well-being and to the public health. Clinical trials and meta-analyses evidence supports the effectiveness of Screening, Brief Intervention and Referral to Treatment (SBIRT) for adolescents with substance misuse, and SBIRT is recommended by the American Academy of Pediatrics. Despite federal support of SBIRT, primary care providers have been slow to adopt this evidence-based approach. Thus, research is needed to determine effective ways to implement SBIRT for adolescents so that this approach can be brought to scale and achieve its full public health impact. Guided by Proctor's conceptual model of implementation research, the proposed study is a multi-site, cluster randomized trial to compare two principal strategies of SBIRT delivery within adolescent medicine. In the Generalist Strategy, the primary care provider delivers brief intervention (BI) fo substance misuse. In the Specialist Strategy, BIs are delivered by behavioral health counselors. The 8 study sites, primary care clinics operated by a large, urban Federally Qualified Health Center in Baltimore, will be randomly assigned to implement SBIRT for adolescents using either the Generalist or Specialist strategies. Staff at each site will be trained in the assigned implementation strategy, and quarterly booster trainings will be provided during the implementation period. Implementation outcomes, including: penetration, costs/cost- effectiveness, acceptability, timeliness, fidelity/adherence, and patient satisfaction will be assessed during the 18-month-long implementation period using a complementary combination of administrative service encounter data, provider and patient surveys, and qualitative interviews. At the end of the active implementation period, all training and technical support activities will cease for 12 months in order to measure relative sustainability. Specific Aims are: (1) to examine the relative effectiveness of the Generalist v. the Specialist implementation strategies in terms of penetration of (i) BI for those adolescents for whom it is indicated and (ii referral to specialty substance abuse treatment when indicated; (2) To determine the (iii) cost and (iv) cost-effectiveness of the two strategies; and (3) to compare the two strategies in terms of key implementation factors, including (v) acceptability; (vi) timeliness; (vii) fidelity/adherene; (viii) patient satisfaction; and (ix) sustainability. The proposed study is significant because it ill fill a major gap in scientific knowledge regarding the best SBIRT implementation strategy at a time when SBIRT is poised to be brought to scale under health care reform. It is innovative because it will be the first implementation study of adolescent SBIRT and one of the first prospective trials to use an implementation science conceptual framework for brief interventions. Finally, the study will include novel cost data that will provide guidance about the adoption of SBIRT in adolescent health care.