Virtual SBIRT for Pediatric Primary Care: Increasing Access to Screening, Brief Intervention and Referral to Treatment for Alcohol and Other Drug Use via Telehealth

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PROJECT SUMMARY/ABSTRACT Adolescent alcohol and other drug (AOD) use is a major public health concern posing significant challenges to healthcare providers, patients and families. It is associated with comorbid psychiatric and medical conditions, poor educational and employment outcomes, accidents and injuries, and avoidable health services utilization and costs (e.g., emergency and inpatient). Early AOD use initiation is associated with alcohol use disorders in adulthood. Screening, Brief Intervention and Referral to Treatment (SBIRT) delivered in pediatric primary care is an effective approach to early identification and intervention and can reduce both AOD use and consequences and co-occurring mental health symptoms, yet widespread implementation is lacking, due to a variety of barriers, including the time constraints and competing priorities faced by pediatricians and lack of trained staff. Research on efficient and cost-effective modalities of SBIRT delivery in pediatric primary care is critical to expanding the evidence base and supporting broader implementation. Accelerated by the pandemic, behavioral telemedicine approaches to addressing adolescent AOD use and mental health problems are gaining momentum and offer the potential to increase the reach and impact of SBIRT in pediatric primary care. This study’s objective is to examine whether a centralized, virtually delivered modality of SBIRT, rapidly accessible by multiple pediatric primary care clinics, can be cost-effectively implemented to improve early identification and treatment for AOD and comorbid mental health problems among adolescents at high or severe risk of AOD use disorder . In this wholly pragmatic, Type 1 Hybrid Comparative Effectiveness Implementation trial, set in a large, real-world health system with a highly diverse population, we will randomize 20 busy, general pediatric primary care clinics with an eligible population of approximately 22,320 12-17 year old adolescents, to one of two intervention arms: 1) clinics where brief interventions are delivered virtually by video or telephone by a centralized behavioral health clinician (CV-SBIRT arm), or 2) clinics where appointment-based brief interventions are delivered by a behavioral health clinician assigned to the clinic (Traditional SBIRT arm). Licensed behavioral health clinicians in both arms will be trained in the same empirically supported SBIRT protocol, differing only in its modality of delivery. The sample will include all adolescents aged 12 through 17 years seen for a Well Visit, who are at high or severe risk of AOD use disorder defined as endorsing monthly or more frequent AOD use OR any AOD use and past-two-week depressive symptoms or suicidality. We will use administrative and clinical data collected in the electronic health record during routine care to compare SBIRT implementation (rates of brief interventions and referrals), AOD and mental health outcomes (use frequency and symptom endorsement and diagnoses), specialty Addiction Medicine and Psychiatry treatment initiation and engagement, health services use (inpatient and Emergency Department), and cost-effectiveness in the intervention arms, at 1 and 2 years post-screening.