A randomized clinical trial of SBIRT services in school-based health centers

学校健康中心 SBIRT 服务的随机临床试验

• 批准号: 8845183
• 负责人: Jan Gryczynski
• 金额: $ 61.73万
• 依托单位: FRIENDS RESEARCH INSTITUTE, INC.
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-05-15 至 2018-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8845183
• 关键词: Academy; Acute; Address; Adolescent; Adolescent Medicine; Adoption; Adult; Age; Alcohol consumption; Alcohol or Other Drugs use; Alcoholic Intoxication; American; Baltimore; Caring; Childhood; Chronic Disease; Cities; Clinic; Clinical effectiveness; Computers; Contraceptive methods; Cost Effectiveness Analysis; Data; Drug usage; Economics; Eligibility Determination; Enrollment; Evaluation; Female Adolescents; Frequencies; Funding; HIV; HIV risk; Health; Health Benefit; Health Services; Healthcare; Illicit Drugs; Immunization; Individual; Intervention; Longevity; Male Adolescents; Marijuana; Maryland; Medical; Modeling; National Institute of Drug Abuse; Nurse Practitioners; Outcome; Participant; Pathway interactions; Patient Self-Report; Pattern; Pediatrics; Process; Provider; Public Health; Publishing; Quality-Adjusted Life Years; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Reporting; Research; Research Design; Risk; Risk Behaviors; Risk Factors; Risk Reduction; Sample Size; Schools; Services; Sex Behavior; Sexually Transmitted Diseases; Substance abuse problem; Tablets; Time; United States; Unsafe Sex; Visit; Youth; adolescent patient; adolescent substance use; alcohol risk; arm; base; behavioral outcome; binge drinking; brief advice; brief intervention; comparative; comparative effectiveness; computer program; computerized; cost; cost effective; cost effectiveness; drinking; early onset substance use; evidence base; experience; follow-up; health care delivery; health care model; high school; innovation; instrument; marijuana use; member; motivational enhancement therapy; novel; patient oriented; randomized trial; reduce marijuana use; reduced alcohol use; routine practice; scale up; school health; screening; screening, brief intervention, referral, and treatment; sex; sex risk; social; substance abuse treatment; substance using adolescents; twelfth grade

DESCRIPTION (provided by applicant): Substance use among adolescents continues to be highly prevalent in the US. Likewise, many adolescents engage in sexual behaviors that place them at elevated risk for HIV and other sexually transmitted infections. Screening, brief intervention, and referral to treatment (SBIRT) is a promising approach for integrating substance use services into healthcare settings. School-based health centers (SBHCs) are a rapidly expanding model of healthcare delivery offering health services far beyond those of the traditional school health office. Implementing SBIRT in SBHCs could have major public health benefits, but research is needed to identify the most effective way to deliver SBIRT for adolescents in these settings. Two approaches for SBIRT that are particularly promising in their practicality, scalability, and sustainability are nurse practitioner-delivered brief intervention ad computer-delivered brief intervention. We propose to conduct a randomized controlled trial to determine the comparative clinical effectiveness and cost-effectiveness of these two approaches in reducing marijuana use, alcohol use, and sex risk behaviors. The study will be conducted in SBHCs embedded within two public high schools in Baltimore, Maryland. SBHC patients ages 14-18, inclusive, will be screened for eligibility by research staff with the CRAFFT, a brief substance misuse screening instrument recommended by the American Academy of Pediatrics. The study will enroll 300 male and female adolescents who report risky marijuana or alcohol use. Participants will be randomly assigned to receive a nurse practitioner-delivered brief intervention (NBI) consisting of brief motivational advice as part of their medical visit, ora promising interactive computer-delivered brief intervention (CBI) based on motivational interviewing. Both intervention conditions will include HIV risk reduction content tailored based on individual risk factors, and both conditions will include a referral pathway for additional substance abuse assessment and possible treatment by specialized substance abuse treatment staff. Research assessments will be conducted at baseline and at 3- and 6-month follow-up, and will gather self-reported data on substance use and sexual risk behaviors. A focused economic analysis will compare the NBI and CBI conditions with respect to their incremental cost-effectiveness for selected primary behavioral outcomes and for quality-adjusted life years (QALYs). A qualitative process evaluation will examine adolescent participants' and SBHC staff members' perspectives on the competing BI strategies. This study has the potential for significant public health impact because it could identify the most effective SBIRT model for addressing adolescent substance use and HIV risk behaviors, both of which can have major health repercussions in the near-term and over the lifespan. The study is highly innovative in its focus on SBHCs, a rapidly expanding healthcare model that is uniquely suited to maximize the impact and reach of SBIRT for adolescents. It will be the largest randomized trial of SBIRT in US high schools, the first study of SBIRT in SBHCs, and the first study of SBIRT for adolescents in any setting to include an economic analysis.

描述（由申请人提供）：青少年的物质使用在美国仍然非常普遍。同样，许多青少年的性行为使他们感染艾滋病毒和其他性传播疾病的风险增加。筛选，短暂干预和转诊治疗（SBIRT）是一个很有前途的方法，将物质使用服务纳入医疗保健设置。以学校为基础的保健中心（shhcs）是一种迅速发展的保健服务模式，提供的保健服务远远超过传统的学校保健办公室。在shbhcs实施SBIRT可能会带来重大的公共卫生效益，但需要进行研究，以确定在这些环境中为青少年提供SBIRT的最有效方法。有两种方法在实用性、可扩展性和可持续性方面特别有前途，即护士执业人员提供的简短干预和计算机提供的简短干预。我们建议进行一项随机对照试验，以确定这两种方法在减少大麻使用、酒精使用和性危险行为方面的比较临床效果和成本效益。这项研究将在马里兰州巴尔的摩市两所公立高中的shhcs内进行。年龄在14-18岁（含）的shbhc患者将由craft的研究人员筛选是否符合资格。