A Clinical Trial of SBIRT Services in School-based Health Centers
Condition: Marijuana Use; Alcohol Consumption; Unsafe Sex; Risk Behavior
MeSH terms: Alcohol Drinking; Marijuana Use
Study type: Interventional

Summary: 
      The purpose of the study is to examine the comparative effectiveness of a computerized brief
      intervention vs. an in-person brief intervention delivered by a nurse in reducing marijuana,
      alcohol, and sex risk behaviors in adolescents receiving services in school-based health
      centers.
    

Detailed description: 
      Substance use among adolescents continues to be highly prevalent in the US. Likewise, many
      adolescents engage in sexual behaviors that place them at elevated risk for HIV and other
      sexually transmitted infections. Screening, brief intervention, and referral to treatment
      (SBIRT) is a promising approach for integrating substance use services into healthcare
      settings. School-based health centers (SBHCs) are a rapidly expanding model of healthcare
      delivery offering health services far beyond those of the traditional school health office.
      Implementing SBIRT in SBHCs could have major public health benefits, but research is needed
      to identify the most effective way to deliver SBIRT for adolescents in these settings. Two
      approaches for SBIRT that are particularly promising in their practicality, scalability, and
      sustainability are nurse practitioner-delivered brief intervention and computer-delivered
      brief intervention. This randomized controlled trial seeks to determine the comparative
      clinical effectiveness and cost-effectiveness of these two approaches in reducing marijuana
      use, alcohol use, and sex risk behaviors. The study will be conducted in SBHCs embedded
      within public high schools in Baltimore, Maryland. SBHC patients will be screened for
      eligibility by research staff with the CRAFFT, a brief substance misuse screening instrument
      recommended by the American Academy of Pediatrics. The study will enroll 300 male and female
      adolescents who report risky marijuana or alcohol use. Participants will be randomly assigned
      to receive a nurse practitioner-delivered brief intervention (NBI) consisting of brief
      motivational advice as part of their medical visit, or a promising interactive
      computer-delivered brief intervention (CBI) based on motivational interviewing. Both
      intervention conditions will include HIV risk reduction content tailored based on individual
      risk factors, and both conditions will include a referral pathway for additional substance
      abuse assessment and possible treatment by specialized substance abuse treatment staff.
      Research assessments will be conducted at baseline and at 3- and 6-month follow-up, and will
      gather self-reported data on substance use and sexual risk behaviors. A focused economic
      analysis will compare the NBI and CBI conditions with respect to their incremental
      cost-effectiveness for selected primary behavioral outcomes and for quality-adjusted life
      years (QALYs). A qualitative process evaluation will examine adolescent participants' and
      SBHC staff members' perspectives on the competing BI strategies. This study has the potential
      for significant public health impact because it could identify the most effective SBIRT model
      for addressing adolescent substance use and HIV risk behaviors, both of which can have major
      health repercussions in the near-term and over the lifespan. The study is highly innovative
      in its focus on SBHCs, a rapidly expanding healthcare model that is uniquely suited to
      maximize the impact and reach of SBIRT for adolescents.
    

Intervention name(s): Brief in-person motivational intervention; Computerized Brief Intervention
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Brief in-person motivational intervention tailored to participants' risk behaviors, delivered by a nurse.; Computer-delivered motivational intervention tailored to participants' risk behaviors.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research