Substance Use Screening and Prevention for Adolescents in Pediatric Primary Care

医保法的最新发展支持以初级保健为基础的干预措施，以防止药物使用 精神障碍(SUD)及相关行为问题。然而，专门为以下目的设计的循证计划 缺乏医疗保健设置。这项建议是为了测试整合和调整两个NIDA的有效性- 为低收入青年服务的初级保健儿科诊所使用的资助程序：1)紧急指标 (UI)-护士管理的高中前物质使用高风险(SU)筛查工具，因此还 对于SUD和2)家庭检查(FCU)-一项简短的基于家庭的计划，可通过复制预防SU/SUD 功效。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，这些障碍阻碍了SU预防的筛查和转诊治疗方法 在初级保健方面。UI/FCU集成计划解决了所有六个障碍。UI/FCU方法一直是 在健康儿童体检期间被青少年患者、他们的父母和 他们的医生。UI和FCU目前正在进行的研究中使用，尽管是平行的，与 儿科医生是这一提议的合作者，但他们还没有被整合到同一个项目中。这个 以下三个目标侧重于评估和完善初级保健UI/FCU方案的调整 使用：1)复制用户界面筛选工具在并发和预测有效性方面的有效性，以及 FCU的参与率；2)确定和解决在实施和整合 在为城市低收入青年服务的初级保健诊所内实施UI/FCU预防战略；以及3)测试 UI/FCU对新出现的SU、性行为和品行问题的有效性，以及假定的 这些结果的中介者包括育儿和父母的幸福。基于先前的FCU效力 研究表明，500对父母及其10至13岁的孩子来自低收入、种族多元化的家庭 将从城市社区的一家大型初级保健诊所招募。这个样本提供了统计上的力量 即使在分组(例如，年龄、性别、种族)中也要进行有效性测试。FCU将为两人或两人提供 三年来测试剂量的影响。参与者将在完成FCU后一年内接受随访 评估整合的UI/FCU的纵向结果。除了传统的有效性评估外， 分析将测试UI/FCU结果的调解人和调解人，以及预干预 风险因素的人内变异性(除基线得分外)预测结果。这种方法 代表着通过提供干预措施在SU/SUD预防方面取得转型进展的关键一步 来自儿科初级保健，满足该专业确定的需求，提供财政自给自足， 提供传播基础设施，确定每年患者的多个告密者(儿童和家长) 监测，并作为个体化干预的场所。

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, 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.