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: 9557687
• 负责人: Sion Kim Harris
• 金额: $ 20.98万
• 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 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9557687
• 关键词: Abstinence; Accidental Injury; Accreditation; Address; Adolescence; Adolescent Medicine; Alcohol consumption; Alcohol or Other Drugs use; American; Belief; Brain Injuries; Certification; Cessation of life; Child health care; Childhood; Clinical; Collection; Consensus; Contracts; Data; Development; Drowning; Early Intervention; Education; Effectiveness; Elements; Ethanol toxicity; Evaluation; 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; Phase; Prevention education; Preventive Intervention; 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; dual diagnosis; education resources; efficacy testing; emotion regulation; evidence base; follow-up; high risk sexual behavior; improved; innovation; intervention program; liver injury; lung injury; motivational enhancement therapy; prevent; programs; recruit; screening; screening and brief intervention; screening participation; social; substance use prevention; theories; treatment as usual; web site

Substance​ ​Use​ ​Project​ ​Summary 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​ ​​c​omputerized​ ​alcohol​ ​and​ ​substance​ ​use​ ​computerized​ ​​S​creening and​ ​provider​ ​​B​rief​ ​​A​dvice​ ​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.

药物使用项目摘要 通常在青少年期间开始使用物质（90％），造成大脑和肝脏损害，风险 性和驾驶行为，并有可能导致成瘾，因此预防和早期 需要针对青少年的干预计划来防止这种发病率，获得产品 生命多年并降低成本。该提案提出了创新，以克服 通过进一步访问初级保健期间有效解决青少年物质使用 开发有前途的计算机酒精和药物使用计算机筛选 以及提供商简短咨询系统（CSBA），并与在线集成“临床过程 支持系统”称为Chadis。Chadis满足了所有儿科筛查需求，IS 目前广泛用于小儿练习，使chadis-csba的广泛传播 模块立即可行。但是，由于与时间和培训有关的局限性 动机访谈的方法（MI），有强有力的证据证明行为改变 在药物用户中，不是CSBA的一部分。这里提出的创新将需要访问前青少年 与优势和目标有关的数据，并确认使用的原因是 PCP护理时可以访问的个性化“远程编制”以及 共享图形表示，用于增强禁欲或激励停产 用法。此外，讨论青少年确定的优势和目标的提示将包括 青少年研究的措辞使用“增量理论”（或者相信人们有 改变的潜力），这表明社会应对的改善。 Chadis-CSBA 还将为每个青少年提供一个自信的个人门户，自动填充 支持其认可的优势和其他支持以及与物质有关的随访 消息传递。访问后的父母教育将包括访问青少年安全课程。青少年发现 严重的药物滥用或双重诊断将通过护理准备 协调功能。 PCP参与将由美国董事会加强 儿科认可的质量改进计划，用于其要求的重新认证（MOC-4）。 在第1阶段，Chadis-CSBA模块将与专业和青少年反馈一起创建 并获得了MOC-4认证。在第2阶段中，将导致最终系统；一个基线 进行药物使用筛查；然后，Chadis-CSBA模块将随机分配给 医生和质量改进干预措施将衡量降低费率 与治疗相比，在3和12个月的随访中使用的任何物质使用。