Implementing adolescent SBIRT in primary care: Stopping the problem where it starts
New Hampshire has among the highest rates of adolescent and young adult substance misuse in the U.S., ranking worst of 50 states for population prevalence of alcohol use among 12 to 20 year olds. Prior to this project, there was no standard protocol for primary care providers in New Hampshire to screen adolescents for substance use disorders. The American Academy of Pediatricians (AAP) has recommended that adolescents receive screening and guidance regarding substance use during routine clinical care as part of a comprehensive SBIRT (Screening, Brief Intervention and Referral to Treatment) program.
Guided by methods of implementation research, we sought to understand how adolescent SBIRT works in real-world settings, how to make it work better, inform stakeholders about the innovation, and address confidentiality concerns. We conducted observational studies on program adaptation, team learning and scaling-up, and a patient experience survey. The project was implemented as a pilot, improved using Plan-Do-Study-Act cycles of change, then scaled up to 14 primary care practices. Research questions addressed topics related to acceptability, adoption and feasibility of SBIRT implementation applicable to primary care practices nationwide.
We found that primary care providers were receptive to, and became adept at, administering a comprehensive SBIRT program to screen adolescent patients for substance use, given appropriate training and adequate resources. The reactions of adolescent patients and their parents to this new screening and intervention were mixed but generally positive. Barriers were identified and mitigation approaches were developed to promote success.
This study produced protocols to scale up SBIRT throughout a regional health system. Organizational factors including training, communication and outreach were supportive of success. Accessible technical advice, and policy analysis and advocacy were found to be additional keys to success. Getting the right people involved in the project, and effective physician championship were instrumental to positive results.
Learning Areas:Ethics, professional and legal requirements
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Provision of health care to the public
List key factors that promote successful implementation of SBIRT among adolescents in primary care. Identify issues surrounding, and procedures for protecting, patient confidentiality related to adolescent SBIRT. Discuss the role of the primary care provider in implementing adolescent SBIRT.
Keyword(s): Adolescents, Prevention
Qualified on the content I am responsible for because: I have conducted research as principal investigator on the topic of alcohol use and behavioral health in a primary care setting for the past seven years. As PI and Project Director, I have successfully implemented adolescent and young adult SBIRT in a primary care setting.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.