**Children's Hospital Boston**

**Program Description**

The purpose of our program is: 

1. To develop a curriculum to teach pediatric clinicians Screening, Brief Intervention and Referral to Treatment (SBIRT) skills specific for adolescent patients; 

2. To implement this curriculum with pediatric residents in the Boston Combined Residency Program in Pediatrics and Child and Adolescent Psychiatry Residency at Children's Hospital Boston; and 

3. To widely disseminate the curriculum and training materials to pediatrics and family medicine faculty through regional train the trainers workshops and nationally via the Internet. The primary factor that distinguishes this program from other SAMHSA grant recipients is the focus on adolescents. Another unique part of our program is a detailed plan to implement SBIRT in Pediatric Emergency Departments. The project intends to train 230 residents over the five year life of the cooperative agreement. 

Our project will immediately impact the greater-Boston area serving an adolescent population with diverse backgrounds and socioeconomic status. This project affects 12- to 21-year-old medical patients from all socio-economic levels, living in urban, suburban, and rural settings. The project will also affect the practices of PCPs, physician assistants, nurse practitioners, and general and pediatric dentists. Over the course of 3 years, we expect to train 117 pediatric residents, given 41 residents per year and a 95 % retention rate.

**Program Model**

In coordination with the Massachusetts Department of Public Health, we have designed an algorithm for implementing SBIRT for adolescents in the primary care department. Given the specialized needs of the psychiatric and emergency departments, we have customized the algorithm for use in those settings. In all settings, the validated CRAFFT screening tool (preceded by 3 unambiguous opening questions on drug use) will be used to assess the level of risk for substance abuse.

Residents will receive training in these six specific areas: 

1. General overview of screening, assessment and brief advice; 

2. Brief interventions; 

3. Appropriate prescribing practices for stimulants; 

4. Appropriate prescribing practices for opioids and other pain medications; 

5. Effective use of laboratory testing for drugs; 

6. Prescribing effective medications to treat cravings and prevent relapse. 

The curriculum will address issues of patient confidentiality, parental involvement, and different approaches to depending on the developmental level of the patient. Training will be didactic and "hands-on" with refresher courses offered via the hospitals intranet.

**Service Features**

Childrens Hospital is the sole site of the eleven 2008 CSAT-SAMHSA grantees with a focus on adolescents. We will evaluate the success of our program based on trainee and faculty satisfaction, trainee behavior and trainee knowledge. Through the addition of self administered, computer-based lessons with basic information from each of our curriculum modules, we will expand the staff we can train to include faculty, residents in different years, and fellows in a variety of programs at the hospital. To further expand the impact of this project, we will post the entire final curriculum on the Internet at www.pedicases.org. The Pedicases website has a national audience of pediatric faculty and trainees, with over 730 new registered users per year. We will also disseminate the curriculum and training materials to pediatrics and family medicine faculty through board review courses, hospital rounds, regional train the trainers workshops and through national workshops such as Association of Pediatric Program Directors (APPD), Association for Medical Education and Research in Substance Abuse (AMERSA), the Pediatric Academic Societies (PAS) and the American Academy of Pediatrics National Convention and Exhibition (AAP NCE) to the greatest extent of our ability.

**Contact Info**

Children's Hospital Boston/ CeASAR300 Longwood AvenueBoston, MA 02115Phone: 617-355-5433Fax: 617-730-0049

Project DirectorDr. Sharon LevyPhone: 857-218-4308Fax: 617-730-0049Sharon.Levy@childrens.harvard.edu

Co-DirectorDr. John KnightPhone: 617-355-5433Fax: 617-730-0049John.Knight@childrens. harvard.edu

EvaluatorDr. Sion HarrisPhone: 857-218-4304Fax: 617-730-0049Sion.Harris@childrens.harvard.edu