Workforce and System Change to Treat Adolescent Opioid Use Disorder within Integrated Pediatric Primary Care

摘要 青少年服药过量死亡的风险越来越大。自2020年以来，吸毒过量危机的扩大速度最快 在年轻人中，主要是因为最近的现实是，任何非法物质(如假冒) 青少年使用的毒品、甲基苯丙胺)可能含有致死量的 芬太尼。预防过量死亡需要识别和治疗患有任何药物使用障碍的年轻人。 (SUD)或偶尔使用阿片类药物--包括但不限于阿片类药物使用障碍(OUD)--由于潜在的芬太尼 污染。青少年获得经验丰富、合格的SUD/OUD治疗提供者的机会远远低于 与需要治疗的成年人相比，存在更大的差距。将专家添加到 劳动力将有所帮助，但国家吸毒过量危机的紧迫性要求对目前的情况进行创新 建立青少年SUD/OUD护理模式，以改善有效的评估和治疗服务。 初级保健提供者(PCP)可以填补部分行为卫生劳动力的缺口，但他们经常 缺乏正规的肥胖症培训和资源，感觉没有资格诊断和治疗肥皂症，特别是在年轻人中。 综合护理模式，在这种模式下，PCP与行为健康专家密切合作，提供适当的护理 对于SUD/OUD患者来说，是一种有希望但在儿科环境中研究不足的方法。因此，在 根据国家专家和当地利益相关者的意见，研究小组将进行混合类型2有效性- 实施，整群随机试验，研究多方面干预，以改变程序和 儿科小学环境的文化规范。该项目充分利用了通过 在全州卫生系统中大规模推出综合行为健康(IBH)。干预组件 对于这个青少年SUD IBH，包括在初级保健中的任务转移，以促进简短的SUD的交付 干预、病例管理、电子决策支持工具和减少耻辱的干预措施。这个 拟议干预的主要目的是正式合并和建立通过以下途径提供的资源 这些干预措施旨在将初级保健实践转变为提供有效的青少年SUD护理，并最终， 以防止青少年服药过量死亡。

SUMMARY Adolescents are at increasing risk of overdose death. Since 2020, the overdose crisis has expanded most rapidly among younger populations, largely because of the recent reality that any illicit substance (e.g., counterfeit pharmaceuticals, methamphetamines) used by adolescents has the potential to contain lethal amounts of fentanyl. Preventing overdose deaths will require identifying and treating youth with any substance use disorder (SUD) or occasional opioid use – including but not limited to opioid use disorder (OUD) – due to potential fentanyl contamination. Access to experienced, qualified SUD/OUD treatment providers for adolescents is far below what is needed, with an even greater disparity noted than for adults needing treatment. Adding specialists to the workforce will help, but the urgency of the national overdose crisis requires innovative changes to current adolescent SUD/OUD care models to improve availability of effective assessment and treatment services. Primary Care Providers (PCPs) could fill a portion of the gap of the behavioral health workforce, but they often lack formal SUD training and resources and feel unqualified to diagnose and treat SUDs, particularly in youth. Integrated care models, where PCPs work closely with behavioral health specialists to deliver appropriate care to patients with SUD/OUD, are a promising but understudied approach in pediatric contexts. Therefore, with input from national experts and local stakeholders, the research team will conduct a Hybrid Type 2 effectiveness- implementation, cluster-randomized trial to study a multifaceted intervention to change the procedural and cultural norms of pediatric primary settings. This project capitalizes on the infrastructure established through a large-scale roll out of integrated behavioral health (IBH) in a statewide health system. Intervention components for this adolescent SUD IBH include task-shifting within primary care to facilitate delivery of brief SUD interventions, case management, electronic decision support tools, and stigma-reduction interventions. The primary purpose of the proposed intervention is to formally combine and build on the resources available through these interventions to shift primary care practice toward delivering effective adolescent SUD care and, ultimately, to prevent overdose deaths among adolescents.