Online System for Primary Care to Prevent and Address Teen Substance Use

药物使用通常(90%)开始于青春期，导致大脑和肝脏损伤，有性行为风险 和驾驶行为，并有可能导致成瘾，因此预防和及早 需要针对青少年的干预计划，以防止这种发病率，获得富有成效的年龄段 减少生活成本，降低成本。这项提案提出了克服障碍的创新之处 通过进一步发展有效解决青少年在初级保健就诊期间使用药物的问题 前景看好的计算机化酒精和物质使用计算机化筛查和提供者简介 咨询系统(CSBA)以及与名为 查迪斯。CHADIS解决了所有儿科筛查需求，目前广泛用于儿科 使CHADIS-CSBA模块的广泛传播立即成为可能的做法。然而， 由于时间和培训的限制，动机访谈(MI)的方法， 有强有力的证据表明影响药物使用者的行为改变，不是CSBA的一部分。一个 这里提出的创新将采用访问前青少年的与优势和目标相关的数据，并 确认使用的原因，以填充目前可访问的个性化“电视提示器” PCP的注意事项以及共享用于加固的图形表示的选项 禁欲或鼓励停止使用。此外，青少年讨论的提示 确定的优势和目标将包括来自青少年研究的措辞，使用“增量理论”(或 相信人们有改变的潜力)，这表明在 社交应对。CHADIS-CSBA还将为每个青少年提供一个机密的个性化门户 自动填充对其认可的优势和其他支持的支持以及 与物质相关的后续信息。探视后的家长教育将包括接触青少年 安全航线。被发现有严重药物滥用或双重诊断的青少年将得到转诊 由护理协调功能促进。PCP的参与将由一名美国人加强 儿科委员会认可的质量改进计划，用于他们需要的重新认证 (MOC-4)。在第一阶段，将创建CHADIS-CSBA模块，包括专业人员和青少年 获得反馈和MOC-4认证。在第二阶段，将对所产生的系统进行试验；a 进行物质使用筛查的基线；然后CHADIS-CSBA模块将被随机分配到 将进行医生和质量改进干预，以衡量 与常规治疗相比，在3个月和12个月的随访中使用任何物质。

Substance use usually (90%) begins during adolescence, causing brain and liver damage, risky sexual and driving behavior, and potentially leading to addiction therefore prevention and early intervention programs targeting teens are needed to prevent this morbidity, gain productive years of life and reduce costs. This proposal presents innovations to overcome the barriers to effectively addressing teen substance use during primary care visits through further development of a promising computerized alcohol and substance use computerized Screening and provider Brief Advice system (cSBA) and integration with an online “clinical process support system” called CHADIS. CHADIS addresses all pediatric screening needs and is currently widely used in pediatric practice making widespread dissemination of a CHADIS-cSBA module immediately feasible. However, because of limitations related to time and training the approach of motivational interviewing (MI), with strong evidence for effecting behavior change in substance users, was not a part of cSBA. An innovation proposed here will take pre-visit teen data related to strengths and goals and acknowledged reasons for usage to populate individualized “teleprompters” accessible at the moment of care by PCP’s along with options for sharing graphical representations for use in reinforcing abstinence or motivate discontinuing usage. In addition, the prompts for discussion of teen identified strengths and goals will include wording from teen studies using “incremental theory”(or the belief that people have the potential to change), which has shown result in improvements in social coping. CHADIS-cSBA will also provide each teen a confidential individualized portal automatically populated with supports for their endorsed strengths and other supports as well as substance-related follow-up messaging. Post-visit parent education will include access to a Teen Safe course. Teens found to have serious substance abuse or dual diagnoses will have referrals facilitated by care coordination functionality. PCP participation will be reinforced by a American Board of Pediatrics accredited quality improvement program for their required re-certification (MOC-4). In Phase 1, the CHADIS-cSBA module will be created with both professional and teen feedback and MOC-4 certification obtained. In Phase 2 the resulting system will be piloted; a baseline of substance use screening conducted; then CHADIS-cSBA module will be randomly assigned to doctors and a quality improvement intervention will be conducted to measure reduction in rates of any substance use at 3 and 12 month follow-up compared to treatment as usual.