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

描述（由申请人提供）：在美国，青少年中的物质使用仍然非常普遍。同样，许多青少年的性行为使他们面临更高的艾滋病毒和其他性传播感染风险。筛查、简短干预和转诊治疗（SBIRT）是将物质使用服务纳入医疗环境的一种有前途的方法。学校健康中心（SBHC）是一种快速发展的医疗保健服务模式，提供的健康服务远远超过传统的学校健康办公室。在SBHC中实施SBIRT可能具有重大的公共卫生益处，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。SBIRT的两种方法，特别是有前途的实用性，可扩展性和可持续性是护士护理人员提供的简短干预广告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，酒精使用和性风险行为方面的比较临床有效性和成本效益。该研究将在马里兰州巴尔的摩两所公立高中的SBHC中进行。年龄在14-18岁（含）的SBHC患者将由研究人员用CRAFFT筛选合格性， 美国儿科学会推荐的一种简单的药物滥用筛查工具。该研究将招募300名报告有风险使用大麻或酒精的男性和女性青少年。受试者将被随机分配接受一个由护士提供的简短干预（NBI），包括作为其医疗访视一部分的简短动机建议，或基于动机访谈的有前途的交互式计算机提供的简短干预（CBI）。这两种干预条件都将包括根据个人风险因素量身定制的艾滋病毒风险降低内容，这两种条件都将包括一个转诊途径，以进行额外的药物滥用评估，并由专门的药物滥用治疗人员进行可能的治疗。研究评估将在基线以及3个月和6个月的随访时进行，并将收集有关物质使用和性风险行为的自我报告数据。一个集中的经济分析将比较NBI和CBI的条件下，其增量成本效益为选定的主要行为结果和质量调整生命年（QEARS）。定性过程评估将检查青少年参与者和SBHC工作人员对竞争BI战略的看法。这项研究有可能产生重大的公共卫生影响，因为它可以确定最有效的SBIRT模型来解决青少年物质使用和艾滋病毒风险行为，这两者都可能在短期内和整个生命周期内产生重大的健康影响。该研究在关注SBHC方面具有高度创新性，SBHC是一种快速扩展的医疗保健模式，非常适合最大限度地发挥SBIRT对青少年的影响和影响。这将是美国高中最大的SBIRT随机试验，第一项SBIRT在SBHC中的研究，也是第一项包括经济分析的青少年SBIRT研究。

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.