Trial of Automated Risk Appraisal for Adolescents

描述(由申请人提供)： 在美国，问题药物使用、滥用和相关健康问题在12-25岁的年轻人中的流行继续有增无减，部分原因是错过了及早识别和监测的机会。特别是，改善初级保健环境中青少年和早期青少年对问题药物使用和滥用的认识和持续接触，可以向卫生保健专业人员提供重要信息，并开展早期干预服务。不幸的是，初级保健环境中的常规筛查和监测存在许多障碍。这些问题包括传统的纸张和铅笔筛查的费用，对初级保健临床医生和办公室工作人员的相互竞争的需求，复杂的评分程序，以及随着时间的推移跟踪年轻人的能力。我们的目标是通过对早期识别和监测的研究，为初级保健环境中的青少年改善问题药物使用和滥用以及其他相关健康风险行为的服务。我们扩大了哥伦布儿童医院、离家较近的初级保健中心和Flipsidemedia.com之间的创新合作伙伴关系，以随机试验的方式测试问题药物使用和滥用、抑郁症和相关精神障碍的早期识别和监测系统的有效性和可接受性。我们建议将使用青少年自动风险评估/电话支持(RA/TS)的九个靠近家庭中心的护理与常规护理加邮寄筛查结果(UC+)进行比较。每个站点将被随机分配，从RA/TS的6个月或UC+的6个月开始，然后选择替代方案。RA/TS是一个由青少年在初级保健访问期间完成的基于网络的筛查和评估工具，以及一个链接的、结构化的电话跟踪干预措施，包括向青年及其家人拨打三个后续电话，监测查明的问题和服务障碍。具体地说，我们的目标是1)比较RA/TS青少年和UC+青少年中问题药物的使用和滥用识别的频率；2)检查针对RA/TS青少年和UC+青少年中RA问题药物使用和滥用呈阳性的青少年的咨询、转诊、精神药物或其他干预措施的频率；以及3)评估TS计划在回归初级保健、完成转诊的可能性、初级保健就诊次数、专科就诊次数以及四个月后对服务的满意度方面的效果。

DESCRIPTION (provided by applicant): The pandemic of problem drug use, abuse and related health problems among young persons aged 12-25 in the U.S. continues unabated, in part, because opportunities for early identification and monitoring are missed. In particular, improved recognition of, and ongoing contact for, problem drug use and abuse among pre-teens and early adolescents in primary care settings could provide important information to health care professionals and engage early intervention services. Unfortunately, many barriers exist to routine screening and monitoring in primary care settings. These include the expense of traditional paper and pencil screening, competing demands on primary care clinicians and office staff, complex scoring programs and the ability to track youth over time. Our goal is to improve services for problem drug use and abuse and other related health risking behaviors for youth in primary care settings through research on early identification and monitoring. We expand an innovative partnership among the Columbus Children's Hospital, the Close To Home Primary Care Centers and Flipsidemedia.com to test the efficacy and acceptability of an early identification and monitoring system for problem drug use and abuse, depression and related mental disorders among pre-teens and teenagers in a randomized trial. We propose to compare care in nine Close To Home Centers with Automated Risk Assessment for Adolescents/Telephone Support (RA/TS) compared to usual care plus mailed screening results (UC+). Each site will be randomly assigned to start with six months on RA/TS or six months on UC+ and follow with the alternative. RA/TS is a web-based screening and assessment tool completed by adolescents during primary care visits and a linked, structured telephone tracking intervention consisting of three follow-up telephone calls to youth and their families monitoring identified problems and barriers to services. Specifically, we aim to 1) compare frequency of problem drug use and abuse identification in RA/TS youth vs. youth in UC+; 2) examine frequency of counseling, referral, psychotropic medication or other interventions for youth screening positive for problem drug use and abuse on RA in RA/TS youth vs. UC+ youth; and 3) evaluate the effect of the TS program on return to primary care, likelihood of completing referrals, number of primary care visits, number of specialty visits, and satisfaction with services after four months.