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

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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.