Substance Use Screening and Prevention for Adolescents in Pediatric Primary Care

描述（由申请人提供）：医疗保健法的最新发展支持基于初级保健的干预，以预防物质使用障碍（SUD）和相关行为问题。然而，缺乏专门为医疗机构设计的循证方案。该提案旨在测试整合和调整两种NIDA资助的程序用于为低收入青年提供服务的初级保健儿科诊所的有效性：1）紧急指示器（UI）-一种护士管理的筛选工具，用于高中前物质使用（SU）的高风险，因此也用于SUD; 2）家庭检查（FCU）-一份简报，以家庭为基础的计划，以防止SU/SUD与复制的疗效。最近美国儿科学会的政策要求这种类型的方法来预防SU/SUD，并概述了六个障碍，排除了筛查和治疗方法，在初级保健中预防SU。UI/FCU集成计划解决了所有六个障碍。UI/FCU方法在儿童健康检查的初步研究中得到了年轻患者、他们的父母和医生的热情评价。UI和FCU目前正在进行中，尽管是平行的，与儿科医生合作者的这项建议的研究，但他们还没有被整合在同一个项目。以下三个目标侧重于评估和改进UI/FCU计划在初级保健用途：1）复制UI筛查工具在并发和预测有效性以及FCU参与率方面的有效性; 2）确定和解决在为城市低收入青年服务的初级保健诊所中实施和整合UI/FCU预防策略的挑战;和3）测试UI/FCU对新出现的SU，性活动和行为问题的有效性，以及这些结果的假定调解人，包括养育和父母的幸福感。根据先前的FCU疗效研究，将从城市社区的一个大型初级保健诊所招募500对来自低收入、种族多样化家庭的父母及其10至13岁的子女。该样本为有效性测试提供了统计功效，即使是在亚组中（例如，年龄、性别和种族）。FCU将交付两到三年，以测试剂量的影响。受试者将在完成FCU后一年接受随访，以评价集成UI/FCU的纵向结局。除了传统的有效性估计，分析将测试UI/FCU结局的中介者和调节者，以及干预前风险因素的人内变异性（除了基线评分外） 预测结果。这种方法代表了通过儿科初级保健提供干预来实现SU/SUD预防的转型进步的关键一步，满足了该专业确定的需求，提供了财政自我可持续性，提供了传播基础设施，为每年的患者监测提供了多个信息提供者（儿童和父母），并作为个性化干预的场所。

DESCRIPTION (provided by applicant): Recent developments in healthcare law support primary care-based intervention to prevent substance use disorder (SUD) and related behavior problems. However, evidence-based programs designed specifically for healthcare settings are lacking. This proposal is to test the effectiveness of integrating and adapting two NIDA- funded procedures for use in primary care pediatric clinics serving low-income youth: 1) the Urgency Indicator (UI) - a nurse-administered screening tool for high risk of substance use (SU) prior to high school and thus also for SUD and 2) the Family Check-Up (FCU) - a brief, family-based program to prevent SU/SUD with replicated efficacy. Recent American Academy of Pediatrics policy calls for this type of approach for preventing SU/SUD and outlines six barriers that have precluded a screening and referral-to-treatment approach for SU prevention in primary care. The UI/FCU integrated program addresses all six barriers. The UI/FCU approach has been rated in preliminary research during well-child check-ups with enthusiasm by youth patients, their parents and their physicians. The UI and FCU are currently being used in ongoing, albeit parallel, studies with the pediatrician collaborators of this proposal, but they have yet to be integrated within the same project. The following three aims focus on evaluating and refining the adaptation of the UI/FCU program for primary-care use: 1) to replicate the effectiveness of the UI screening tool in terms of concurrent and predictive validity and the engagement rate in the FCU; 2) to identify and address challenges in implementing and integrating the UI/FCU prevention strategy within a primary care clinic serving urban, low-income youth; and 3) to test the effectiveness of the UI/FCU on emerging SU, sexual activity, and conduct problems, as well as the putative mediators of these outcomes including parenting and parental well-being. Based on prior FCU efficacy studies, 500 dyads of parents and their 10- to 13-year-old children from low-income, ethnically diverse families will be recruited from a large primary care clinic in an urban community. This sample affords statistical power for effectiveness testing even in subgroups (e.g., age, gender, and race). The FCU will be delivered for two or three years to test impact of dosage. Participants will be followed-up one year after completing FCU to evaluate longitudinal outcomes of the integrated UI/FCU. In addition to traditional effectiveness estimates, analyses will test for mediators and moderators of UI/FCU outcomes as well as whether pre-intervention within-person variability in risk factors (in addition to baseline scores) forecast outcomes. This approach represents a critical step toward a transformational advance in SU/SUD prevention by delivering intervention from pediatric primary care which meets a need identified by that profession, offers fiscal self-sustainability, provides infrastructure for dissemination, ascertains multiple informants (child and parent) for yearly patient monitoring, and serves as a venue for individualized intervention.