Health Equity Focused Clinical Decision Supports to Prevent Teen Substance Use in Pediatric Primary Care - PROJECT SUMMARY In the US, complex interactions between social determinants of health and underlying systems of racism and discrimination collectively contribute to multiple health inequities associated with substance use. Upstream prevention efforts can help reduce these inequities. NIDA-funded research has produced numerous evidence- based substance use prevention interventions, including several that are family-focused. Family-focused programs promote protective parenting skills––e.g., provision of warmth, parental monitoring, and positive discipline––to reduce substance use risk in adolescents. Although effective, family-focused programs have limited reach for low-income families due to multiple structural barriers. Integrating family-focused programs into existing infrastructures that serve these families can help overcome barriers. Federally qualified health centers (FQHCs)deliver low-barrier healthcare to30.5 million people (90% of whom live at or below 200% of the Federal Poverty Level). They are ideally positioned to expandequitable access to family-focused prevention programs. In implementation strategy to response to PAR-24-062, Support Pre-Adolescents and families' linkage to substance use pRevention services we propose one of the first studies to co-design (R61) and test (R33) a novel inprimary Care (SPARC).Partnering with parents (i.e., caregivers), clinicians, FQHC leaders, and a non-profit dedicated to strengthening FQHCs across CT, thestudy will occur in alarge FQHC that serves >18,000 low- income children in New Haven, CT. The study brings together a diverse team of experts in adolescent substance use prevention, implementation science, health equity research, and health informatics. SPARC co-designed 12-year-old a locally delivered family-focused substance use prevention program, Guiding Good Choices. Guiding Good Choices has demonstrated effectiveness in preventing adolescent substance use by improving protective parenting skills. Guided by the Health Equity Implementation Framework, Consolidated Framework for Implementation Research, and RE-AIM frameworks, during the R61 Planning Phase, we aim to develop the SPARC implementation strategy with input from diverse stakeholders (R61 Aim 1) and evaluate its usability, acceptability, and feasibility in real-world clinical practice (R61 Aim 2). Upon successful completion of R61 milestones, we will examine SPARC's impact on Guiding Good Choices adoption and reach through a pragmatic RCT of clinicians (R33 Aim 1). We will also examine organizational, clinician (R33 Aim 2), and caregiver-level (R33 Aim 3) factors that influence SPARC's adoption and reach. The engagement of end-users, robust community partnerships, and experts across CT aligns with PAR-24-062's emphasis on community-driven studies that engage community experts. Completing the proposed studies will will include a clinical decision support tool, and referral process to link caregivers of 9 – patients in primary care to clinical recommendation, prepare us to scale evidence-based substance use prevention programs across FQHCs.
