SBIRT Implementation for Adolescents in Urban Federally Qualified Health Centers

描述(由申请人提供)：酒精、烟草和其他药物的使用在美国青少年中仍然非常普遍，并对他们的福祉和公共健康构成威胁。临床试验和荟萃分析证据支持筛查、短暂干预和转诊治疗(SBIRT)对青少年药物滥用的有效性，SBIRT是美国儿科学会推荐的。尽管联邦政府支持SBIRT，但初级保健提供者采用这种循证方法的速度一直很慢。因此，需要研究确定对青少年实施SBIRT的有效方法，以便这种方法能够规模化并实现其对公共卫生的全面影响。在Proctor的实施研究概念模型的指导下，本研究是一项多点、整群随机试验，以比较青少年医学中SBIRT的两种主要策略。在通才策略中，初级保健提供者对物质滥用提供短暂干预(BI)。在专家策略中，BIS由行为健康顾问提供。这8个研究地点是由巴尔的摩一家大型城市联邦合格卫生中心运营的初级保健诊所，将被随机分配，以实施针对青少年的SBIRT，采用通才或专科策略。每个地点的工作人员将接受所分配实施战略的培训，并将在实施期间提供季度助推培训。在长达18个月的实施期间，将使用行政服务接触数据、提供者和患者调查以及定性访谈的补充组合来评估实施结果，包括渗透率、成本/成本效益、可接受性、及时性、忠诚度/遵从性和患者满意度。在积极执行期结束时，所有培训和技术支助活动将停止12个月，以衡量相对可持续性。具体目标是： (1)研究通才与专科实施策略在以下两方面的相对成效：(I)针对指定青少年的性侵犯及(Ii)转介特殊药物滥用治疗；(2)厘定(Iii)成本及(Iv)两种策略的成本效益；及(3)比较两种策略的主要实施因素，包括(V)可接受性；(Vi)及时性；(Vii)忠诚度/依从性；(Viii)病人满意度；及(Ix)可持续性。这项拟议的研究具有重要意义，因为它将填补在SBIRT在医疗改革下有望规模化之际，关于最佳SBIRT实施策略的重大科学知识空白。它具有创新性，因为它将是青少年SBIRT的第一个实施研究，也是第一个使用实施科学概念框架进行简短干预的前瞻性试验之一。最后，这项研究将包括新的成本数据，这些数据将为 SBIRT在青少年保健中的应用 公共卫生相关性：项目描述拟议的研究具有重要意义，因为它将有助于确定一种青少年SBIRT实施策略在覆盖范围、成本效益和城市FQHC环境中的可接受性方面是否优于另一种实施策略，从而填补科学知识的空白，因为SBIRT有望在医疗改革下扩大规模，以减少青少年滥用药物造成的公共健康负担。这项研究具有很高的创新性，因为它将是青少年SBIRT的第一项实施研究，也是第一批使用实施科学概念框架进行药物滥用干预的前瞻性试验之一。此外，这项研究将提供新的成本数据，有助于指导公共和私人卫生保健政策制定者以及诊所主任在青少年卫生保健中广泛采用SBIRT。

DESCRIPTION (provided by applicant): Alcohol, tobacco, and other drug use remains highly prevalent among US adolescents and is a threat to their well-being and to the public health. Clinical trials and meta-analyses evidence supports the effectiveness of Screening, Brief Intervention and Referral to Treatment (SBIRT) for adolescents with substance misuse, and SBIRT is recommended by the American Academy of Pediatrics. Despite federal support of SBIRT, primary care providers have been slow to adopt this evidence-based approach. Thus, research is needed to determine effective ways to implement SBIRT for adolescents so that this approach can be brought to scale and achieve its full public health impact. Guided by Proctor's conceptual model of implementation research, the proposed study is a multi-site, cluster randomized trial to compare two principal strategies of SBIRT delivery within adolescent medicine. In the Generalist Strategy, the primary care provider delivers brief intervention (BI) fo substance misuse. In the Specialist Strategy, BIs are delivered by behavioral health counselors. The 8 study sites, primary care clinics operated by a large, urban Federally Qualified Health Center in Baltimore, will be randomly assigned to implement SBIRT for adolescents using either the Generalist or Specialist strategies. Staff at each site will be trained in the assigned implementation strategy, and quarterly booster trainings will be provided during the implementation period. Implementation outcomes, including: penetration, costs/cost- effectiveness, acceptability, timeliness, fidelity/adherence, and patient satisfaction will be assessed during the 18-month-long implementation period using a complementary combination of administrative service encounter data, provider and patient surveys, and qualitative interviews. At the end of the active implementation period, all training and technical support activities will cease for 12 months in order to measure relative sustainability. Specific Aims are: (1) to examine the relative effectiveness of the Generalist v. the Specialist implementation strategies in terms of penetration of (i) BI for those adolescents for whom it is indicated and (ii referral to specialty substance abuse treatment when indicated; (2) To determine the (iii) cost and (iv) cost-effectiveness of the two strategies; and (3) to compare the two strategies in terms of key implementation factors, including (v) acceptability; (vi) timeliness; (vii) fidelity/adherene; (viii) patient satisfaction; and (ix) sustainability. The proposed study is significant because it ill fill a major gap in scientific knowledge regarding the best SBIRT implementation strategy at a time when SBIRT is poised to be brought to scale under health care reform. It is innovative because it will be the first implementation study of adolescent SBIRT and one of the first prospective trials to use an implementation science conceptual framework for brief interventions. Finally, the study will include novel cost data that will provide guidance about the adoption of SBIRT in adolescent health care. PUBLIC HEALTH RELEVANCE: Project Narrative The proposed study is significant because it will help determine whether one adolescent SBIRT implementation strategy is superior to the other in terms of reach, cost effectiveness, and acceptability within urban FQHC settings, thereby filling a gap in scientific knowledge at a time when SBIRT is poised to be brought to scale under health care reform to reduce the public health burden of adolescent substance misuse. The study is highly innovative, because it will be the first implementation study of adolescent SBIRT and one of the first prospective trials to use an implementation science conceptual framework for substance abuse interventions. Furthermore, the study will provide novel cost data which can help to guide public and private health care policy-makers as well as clinic directors about the widespread adoption of SBIRT in adolescent health care.