Online System for Primary Care to Prevent and Address Teen Substance Use
Total Child Health was awarded a grant from NIDA entitled "Online System for Primary Care to Prevent and Address Teen Substance Use".
Primary Investigator's are Dr. Barbara Howard from Total Child Health, Dr. Raymond Sturner of Center for Promotion of Child Development through Primary Care and co-founder of CHADIS, and Sion Harris, PhD. from the Center for Adolescent Substance Abuse Research (CeASAR) of Boston Children's Hospital, as well as consultation from Dr. John Knight, founder of CeASAR and author of the CRAFFT screening tool.
Substance Use Project Summary
Substance use usually (90%) begins during adolescence, causing brain and liver damage, risky sexual and driving behavior, and potentially leading to addiction, therefore, prevention and early intervention programs targeting teens are needed to prevent this morbidity, gain productive years of life and reduce costs.
This proposal presents innovations to overcome the barriers to effectively addressing teen substance use during primary care visits through further development of a promising computerized alcohol and substance use computerized Screening and provider Brief Intervention system (cSBI) and integration with an online “clinical process support system” called CHADIS. CHADIS addresses all pediatric screening needs and is currently widely used in pediatric practice making widespread dissemination of a CHADIS-cSBI module immediately feasible.
However, because of limitations related to time and training the approach of motivational interviewing (MI), with strong evidence for effecting behavior change in substance users, was not a part of cSBI. An innovation proposed here will take pre-visit teen data related to strengths and goals and acknowledged reasons for usage to populate individualized “teleprompters” accessible at the moment of care by PCP’s along with options for sharing graphical representations for use in reinforcing abstinence or motivate discontinuing usage. In addition, the prompts for discussion of teen identified strengths and goals will include wording from teen studies using “incremental theory”(or the belief that people have the potential to change), which has shown the result in improvements in social coping.
CHADIS-cSBI will also provide each teen a confidential individualized portal automatically populated with supports for their endorsed strengths and other supports as well as substance-related follow-up messaging. Post-visit parent education will include access to a Teen Safe course.
Teens found to have serious substance abuse or dual diagnoses will have referrals facilitated by care coordination functionality. PCP participation will be reinforced by the American Board of Pediatrics accredited quality improvement program for their required re-certification (MOC-4).
In Phase 1, the CHADIS-cSBI module will be created with both professional and teen feedback and certification for doctor-required quality improvement Maintenance of Certification (MOC-4) obtained.
In Phase 2, the resulting system will be piloted; a baseline of substance use screening conducted; then the CHADIS-cSBI module will be randomly assigned to doctors and a quality improvement intervention will be conducted to measure the reduction in rates of any substance use at 3 and 12-month follow-up compared to treatment as usual.
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