Adolescent SBIRT in Pediatric Primary Care: Patient Outcomes From a Randomized Trial in an Integrated Health Care System

Authors

Stacy Sterling, Kaiser Permanente Division of Research, Oakland, CAFollow
Andrea Kline-Simon, Kaiser Permanente Division of Research, Oakland, CA
Ashley Jones, Kaiser Permanente Division of Research, Oakland, CA
Anna Wong, The Permanente Medical Group, Oakland, CA
Derek Satre, Kaiser Permanente Division of Research, Oakland, CA
Constance Weisner, Kaiser Permanente Division of Research, Oakland, CA

Publication Date

8-10-2017

Keywords

child and adolescent health, behavioral and mental health, substance abuse, addiction

Abstract

Background: Many adolescents in need of specialty treatment for substance use and mental health problems never access care. Screening, brief intervention and referral to treatment (SBIRT) is a promising approach to early identification and intervention for adolescent substance use. We describe patient outcomes from a trial of different modalities of SBIRT for adolescents in primary care.

Methods: We randomized pediatricians (N = 52) in a pediatrics clinic to three study arms: 1) pediatrician-only, in which pediatricians were trained to deliver SBIRT; 2) embedded behavioral health clinician (BHC), in which pediatricians referred adolescents who endorsed risk factors (substance use or mood symptoms) to a BHC; and 3) usual care (UC). We used electronic health record (EHR) data to examine risk factors, CRAFFT scores, treatment referral, initiation and engagement.

Results: 1,871 patients were eligible for assessments, brief interventions and referrals. Differences in outcomes between the index and the next well visit within 2 years were examined across the three arms. The odds of risk factor endorsement decreased over time for all patients (adjusted odds ratio [aOR]: 0.07; 95% confidence interval [CI]: 0.05–0.11); the embedded-BHC arm had significantly lower odds of risk factor endorsement compared to UC (aOR: 0.65; 95% CI: 0.43–0.97); there were no differences between UC and the physician-only arm. There were no differences in CRAFFT scores over time or between intervention arms. The embedded-BHC arm had fewer referrals to specialty treatment compared to the other study arms; referral rates between the physician-only and UC arms did not differ. Among those referred, the physician-only arm had significantly lower odds of treatment initiation compared with UC (aOR: 0.53; 95% CI: 0.28–0.99) and the embedded-BHC arm (aOR: 0.25; 95% CI: 0.12–0.49); no differences were found between UC and embedded-BHC. There were no differences in treatment engagement (at least 2 visits within 30 days) across the arms.

Conclusion: Patients in the embedded-BHC arm reported lower behavioral health risk at subsequent screenings, and the embedded-BHC intervention arm was more effective at facilitating treatment initiation for those adolescents needing specialty behavioral health services.

Recommended Citation

Sterling S, Kline-Simon A, Jones A, Wong A, Satre D, Weisner C. Adolescent SBIRT in pediatric primary care: patient outcomes from a randomized trial in an integrated health care system. J Patient Cent Res Rev. 2017;4:192.