PROJECT SUMMARY/ABSTRACT
Adolescent alcohol and other drug (AOD) use is a major public health concern posing significant challenges
to healthcare providers, patients and families. It is associated with comorbid psychiatric and medical conditions,
poor educational and employment outcomes, accidents and injuries, and avoidable health services utilization
and costs (e.g., emergency and inpatient). Early AOD use initiation is associated with alcohol use disorders in
adulthood. Screening, Brief Intervention and Referral to Treatment (SBIRT) delivered in pediatric primary care
is an effective approach to early identification and intervention and can reduce both AOD use and consequences
and co-occurring mental health symptoms, yet widespread implementation is lacking, due to a variety of barriers,
including the time constraints and competing priorities faced by pediatricians and lack of trained staff. Research
on efficient and cost-effective modalities of SBIRT delivery in pediatric primary care is critical to expanding the
evidence base and supporting broader implementation. Accelerated by the pandemic, behavioral telemedicine
approaches to addressing adolescent AOD use and mental health problems are gaining momentum and offer the
potential to increase the reach and impact of SBIRT in pediatric primary care. This study’s objective is to examine
whether a centralized, virtually delivered modality of SBIRT, rapidly accessible by multiple pediatric primary
care clinics, can be cost-effectively implemented to improve early identification and treatment for AOD and
comorbid mental health problems among adolescents at high or severe risk of AOD use disorder . In this wholly
pragmatic, Type 1 Hybrid Comparative Effectiveness Implementation trial, set in a large, real-world health
system with a highly diverse population, we will randomize 20 busy, general pediatric primary care clinics with
an eligible population of approximately 22,320 12-17 year old adolescents, to one of two intervention arms: 1)
clinics where brief interventions are delivered virtually by video or telephone by a centralized behavioral health
clinician (CV-SBIRT arm), or 2) clinics where appointment-based brief interventions are delivered by a
behavioral health clinician assigned to the clinic (Traditional SBIRT arm). Licensed behavioral health
clinicians in both arms will be trained in the same empirically supported SBIRT protocol, differing only in its
modality of delivery. The sample will include all adolescents aged 12 through 17 years seen for a Well Visit, who
are at high or severe risk of AOD use disorder defined as endorsing monthly or more frequent AOD use OR any
AOD use and past-two-week depressive symptoms or suicidality. We will use administrative and clinical data
collected in the electronic health record during routine care to compare SBIRT implementation (rates of brief
interventions and referrals), AOD and mental health outcomes (use frequency and symptom endorsement and
diagnoses), specialty Addiction Medicine and Psychiatry treatment initiation and engagement, health services
use (inpatient and Emergency Department), and cost-effectiveness in the intervention arms, at 1 and 2 years
post-screening.
