A randomized clinical trial of SBIRT services in school-based health centers

描述(由申请人提供)：在美国，青少年使用药物的现象仍然很普遍。同样，许多青少年从事的性行为使他们感染艾滋病毒和其他性传播疾病的风险增加。筛查、短暂干预和转诊治疗(SBIRT)是将物质使用服务整合到医疗保健环境中的一种有前途的方法。校本健康中心(SBHC)是一种快速扩展的医疗保健提供模式，提供的医疗服务远远超过传统的学校健康办公室。在儿童保健中心实施SBIRT可能对公众健康有重大好处，但需要研究确定为这些环境中的青少年提供SBIRT的最有效方式。SBIRT的两种方法在实用性、可扩展性和可持续性方面特别有希望，它们是护士提供的短暂干预和计算机提供的短暂干预。我们建议进行一项随机对照试验，以确定这两种方法在减少大麻使用、酒精使用和性危险行为方面的临床效果和成本效益的比较。这项研究将在马里兰州巴尔的摩两所公立高中内的SBHC中进行。年龄14-18岁(含)的SBHC患者将由CRAFFT的研究人员进行资格筛选， 美国儿科学会推荐的一种简短的药物滥用筛查仪器。这项研究将招募300名报告危险使用大麻或酒精的男性和女性青少年。参与者将被随机分配接受护士实践者提供的简短干预(NBI)，其中包括作为他们就诊一部分的简短激励建议，或者基于激励访谈的承诺的交互式计算机提供的简短干预(CBI)。这两个干预条件都将包括根据个人风险因素量身定做的艾滋病毒风险降低内容，两个条件都将包括转诊路径，以进行额外的药物滥用评估，并可能由专门的药物滥用治疗人员进行治疗。研究评估将在基线和3个月和6个月的随访中进行，并将收集关于药物使用和性危险行为的自我报告数据。重点经济分析将比较NBI和CBI条件在选定的主要行为结果和质量调整寿命年(QALY)方面的增量成本效益。定性过程评估将考察青少年参与者和SBHC工作人员对相互竞争的BI战略的看法。这项研究有可能对公共健康产生重大影响，因为它可以确定解决青少年药物使用和艾滋病毒危险行为的最有效的SBIRT模型，这两者都可能在短期和整个生命周期内对健康产生重大影响。这项研究的重点是SBHCs，这是一种快速扩展的医疗模式，非常适合最大限度地扩大SBIRT对青少年的影响和覆盖范围，具有很强的创新性。这将是美国高中中规模最大的SBIRT随机试验，也是SBIRT在SBHc中的第一次研究，也是第一次在任何环境下对青少年进行SBIRT的研究，其中包括经济分析。

DESCRIPTION (provided by applicant): Substance use among adolescents continues to be highly prevalent in the US. Likewise, many adolescents engage in sexual behaviors that place them at elevated risk for HIV and other sexually transmitted infections. Screening, brief intervention, and referral to treatment (SBIRT) is a promising approach for integrating substance use services into healthcare settings. School-based health centers (SBHCs) are a rapidly expanding model of healthcare delivery offering health services far beyond those of the traditional school health office. Implementing SBIRT in SBHCs could have major public health benefits, but research is needed to identify the most effective way to deliver SBIRT for adolescents in these settings. Two approaches for SBIRT that are particularly promising in their practicality, scalability, and sustainability are nurse practitioner-delivered brief intervention ad computer-delivered brief intervention. We propose to conduct a randomized controlled trial to determine the comparative clinical effectiveness and cost-effectiveness of these two approaches in reducing marijuana use, alcohol use, and sex risk behaviors. The study will be conducted in SBHCs embedded within two public high schools in Baltimore, Maryland. SBHC patients ages 14-18, inclusive, will be screened for eligibility by research staff with the CRAFFT, a brief substance misuse screening instrument recommended by the American Academy of Pediatrics. The study will enroll 300 male and female adolescents who report risky marijuana or alcohol use. Participants will be randomly assigned to receive a nurse practitioner-delivered brief intervention (NBI) consisting of brief motivational advice as part of their medical visit, ora promising interactive computer-delivered brief intervention (CBI) based on motivational interviewing. Both intervention conditions will include HIV risk reduction content tailored based on individual risk factors, and both conditions will include a referral pathway for additional substance abuse assessment and possible treatment by specialized substance abuse treatment staff. Research assessments will be conducted at baseline and at 3- and 6-month follow-up, and will gather self-reported data on substance use and sexual risk behaviors. A focused economic analysis will compare the NBI and CBI conditions with respect to their incremental cost-effectiveness for selected primary behavioral outcomes and for quality-adjusted life years (QALYs). A qualitative process evaluation will examine adolescent participants' and SBHC staff members' perspectives on the competing BI strategies. This study has the potential for significant public health impact because it could identify the most effective SBIRT model for addressing adolescent substance use and HIV risk behaviors, both of which can have major health repercussions in the near-term and over the lifespan. The study is highly innovative in its focus on SBHCs, a rapidly expanding healthcare model that is uniquely suited to maximize the impact and reach of SBIRT for adolescents. It will be the largest randomized trial of SBIRT in US high schools, the first study of SBIRT in SBHCs, and the first study of SBIRT for adolescents in any setting to include an economic analysis.