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以初级保健为基础的干预措施，以预防物质使用障碍(SUD)和相关的行为问题。然而，缺乏专门为医疗保健环境设计的循证程序。这项提议旨在测试整合和调整两种由NIDA资助的程序用于服务低收入青年的初级保健儿科诊所的有效性：1)紧急指标(UI)--一种护士管理的筛查工具，用于高中前的高药物使用风险(SU)，因此也适用于SUD；2)家庭体检(FCU)--一项简短的、以家庭为基础的计划，旨在预防SU/SUD，并具有可复制的疗效。美国儿科学会最近的政策呼吁采用这种方法来预防SU/SUD，并概述了六个障碍，这些障碍已经排除了初级保健中预防SU的筛查和转诊到治疗的方法。UI/FCU集成计划解决了所有六个障碍。在健康儿童体检期间，青少年患者、他们的父母和医生对UI/FCU方法进行了初步研究，并对其进行了热情评价。UI和FCU目前正在与这项提案的儿科医生合作者进行正在进行的研究，尽管是平行的，但它们尚未整合到同一项目中。以下三个目标集中于评估和改进针对初级保健使用的UI/FCU计划的适应性：1)复制UI筛查工具在并发和预测性有效性以及FCU参与率方面的有效性；2)确定和解决在服务于城市低收入青年的初级保健诊所内实施和整合UI/FCU预防战略方面的挑战；以及3)测试UI/FCU对新出现的SU、性行为和行为问题的有效性，以及这些结果的可能中介因素，包括育儿和父母幸福。根据之前的FCU功效研究，来自低收入、种族多元化家庭的500对父母和他们10至13岁的孩子将从城市社区的一家大型初级保健诊所招募。这个样本为有效性测试提供了统计能力，甚至在子组(例如，年龄、性别和种族)中也是如此。FCU将交付两到三年，以测试剂量的影响。参与者将在完成FCU一年后接受随访，以评估整合的UI/FCU的纵向结果。除了传统的有效性评估外，分析还将测试UI/FCU结果的调解人和调解人，以及干预前风险因素(除基线评分外)是否存在人内差异 预测结果。这种方法代表着在SU/SUD预防方面迈出的关键一步，通过提供儿科初级保健的干预，满足该专业确定的需求，提供财政自我维持，提供传播基础设施，确定每年患者监测的多个信息者(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.