Brief training increases pediatrician interventions with at-risk youth

Researchers are studying how to implement proven techniques to identify young people with potential alcohol, substance use, and mental health problems. monkeybusinessimages/iStock/Thinkstock

Substance abuse in adolescence is common and dangerous. Risks range from injuries and school troubles to long-lasting brain changes and dependence. Underage drinking and drug use also often coexist with mental health problems.

Techniques for identifying and treating people with potential alcohol, substance use, and mental health problems are known as screening, brief intervention, and referral to treatment (SBIRT). Research has shown that primary care physicians who conduct SBIRT with adults can reduce heavy drinking, its harmful consequences, and related health care costs. Mounting evidence supports the use of SBIRT by pediatricians to prevent substance use problems from starting or escalating in young patients. However, pediatricians often face barriers to providing these services, including time constraints and a lack of SBIRT training.

A research team led by Dr. Stacy Sterling at Kaiser Permanente Northern California and Dr. Constance Weisner, also at Kaiser and the University of California, San Francisco, examined ways to implement SBIRT in a large pediatric care clinic that treats a racially and socioeconomically diverse population. In this health care system, all adolescents complete a comprehensive health screening tool. Of almost 5,200 patients, ages 12 to 18 years, about 1,900 were eligible and included in the 2-year study. The work was funded by NIH’s National Institute on Alcohol Abuse and Alcoholism (NIAAA). Results appeared on November 2, 2015, in JAMA Pediatrics.

The researchers divided the nearly 50 pediatricians into 3 groups. A “pediatrician-only” group received three 60-minute SBIRT training sessions. They were expected to conduct SBIRT assessments and provide brief interventions as needed in the clinic. A second group of pediatricians underwent a 1-hour training session. They were asked to assess patients and refer them as needed to clinical psychologists who were “embedded” into the practices to conduct interventions. A “usual-care” group of pediatricians had access to the same clinical guidelines and tools as the others, but didn’t take part in SBIRT training or have clinical psychologists embedded in their practices.

The researchers found that, following SBIRT training, the pediatrician-only group was about 10 times more likely than the usual-care group to conduct brief interventions with patients deemed at risk (16% vs. 1.5%). In the group of SBIRT-trained pediatricians who worked with embedded clinical psychologists, the intervention rate was about 25%.

“Both intervention arms administered more assessments and brief interventions than those in usual care,” Weisner says. “However, overall pediatrician attention to behavioral health concerns was still low. Embedding nonphysician clinicians in primary care could be a cost-effective alternative to pediatricians providing these services.”

Future analyses of the study data will examine patient outcomes and cost-effectiveness of the SBIRT approaches.