Pediatric Emergency Department-initiated Support program To Link Care (PEDS-TLC) for youth with substance use - PROJECT SUMMARY/ABSTRACT The purpose of this K23 career development award is to prepare Dr. Renny to become an independent physician-investigator focused on improving care for youth with substance use through emergency department (ED)-based behavioral interventions and use of technology to facilitate interventions and linkages more broadly throughout health systems. In her K23 research project, Dr. Renny will address the critical deficit of research on evidence-based approaches to link youth who use substances with needed outpatient care after their ED visit. She will develop and pilot test a pediatric emergency department-initiated program, the Pediatric Emergency Department-initiated Support program To Link Care (PEDS-TLC) for youth with substance use. PEDS-TLC will link youth who report monthly or more substance use on the Screening to Brief Intervention (S2BI) screening tool (“higher risk for a SUD”) with outpatient care (adolescent medicine or addiction treatment, depending on severity of use) to receive further treatment after their PED visit. In Aim 1, Dr. Renny will adapt and integrate into the electronic health record (EHR) an evidence-based brief negotiated interview (BNI) and change plan for youth at higher risk of a SUD to facilitate linkage to care. Following the ADAPT-ITT framework, and with the assistance of a key stakeholder board and pilot testing by youth, Dr. Renny will adapt the BNI and change plan to be age- and setting-specific, including a more detailed action plan and motivational interviewing theory-based post-PED messaging (e.g., appointment reminders, action plan reminders) as part of the PEDS-TLC program. Once all components of PEDS-TLC are finalized, the action plan and interim messaging will be integrated into the EHR through the EPIC MyChart Care Companion application to assist with transition to outpatient care. In Aim 2, Dr. Renny will conduct a pilot randomized controlled trial (RCT) of the PEDS-TLC program versus standard care to examine feasibility, acceptability, and short-term efficacy of linkage to care and also substance use reduction at 30- and 90-day follow-up. During the K23 award period, Dr. Renny will build on her experience and skills as a pediatric emergency medicine physician, medical toxicologist, and healthcare researcher to gain new expertise in: (1) adapting behavioral interventions for youth with substance use; (2) engaging stakeholders in research; (3) usability testing of information technology (IT) interventions; and (4) designing, executing, and analyzing behavioral intervention trials for youth. She will receive in-depth mentorship from a multi-disciplinary team of experts in ED-based behavioral health interventions, adolescent substance use, stakeholder engagement, IT and digital health, clinical trials, and statistical analysis. The products of this K23 project will provide Dr. Renny with a well- designed, innovative program (PEDS-TLC) and critical preliminary data that informs the anticipated effect size and sample size needed for a subsequent NIH R01 RCT of PEDS-TLC.
