Trial of Automated Risk Appraisal for Adolescents
Condition: Substance Use; Depression; Suicidal Ideation; Risk Behavior
MeSH terms: Substance-Related Disorders; Suicidal Ideation
Study type: Interventional

Summary: 
      This is a study to find out which type of computer screening and nursing support can improve
      screening for high risk behaviors in doctor's offices. Recommendations call for doctors to
      screen young people for many different behaviors and feelings such as depression, not wearing
      seat belts, alcohol and drug use. Doctors rarely have time to complete these screenings. New
      computers can help ask some of these questions and protect patient information. In addition,
      nurse telephone calls can often help young persons with some of the behaviors receive
      treatment. This study will examine which type of computer screening and follow-up will help
      patients the most.
    

Detailed description: 
      The pandemic of problem drug use and abuse and related health problems among young persons
      aged 12-25 in the U.S. continues unabated, in part, because opportunities for early
      identification and monitoring are missed. In particular, improved recognition of, and ongoing
      contact for, problem drug use and abuse among pre-teens and early adolescents in primary care
      settings could provide important information to health care professionals and engage early
      intervention services. Unfortunately, many barriers exist to routine screening and monitoring
      in primary care settings. These include the expense of traditional paper and pencil
      screening, competing demands on primary care clinicians and office staff, complex scoring
      programs and the ability to track youth over time.

      Innovative information technology and support services can overcome many of these barriers.
      New primary care information systems allow for direct data entry by youth in healthcare
      settings, automated scoring and printing, decreased staff time, individual or practice level
      results and patient follow-up for intervention services. However, these assessment tools and
      systems have not been adequately assessed for their roles in detecting problem drug use and
      abuse in youth, and appropriate follow-up and tracking systems for those identified have not
      been implemented.

      Our goal is to improve services for problem drug use and abuse and other related health
      risking behaviors for youth in primary care settings through early identification and
      monitoring. We expand an innovative partnership among the Columbus Children's Hospital, the
      Close To Home Primary Care Centers and Flipsidemedia.com to test the efficacy and
      acceptability of an early identification and monitoring system for problem drug use and
      abuse, depression and related mental disorders among pre-teens and teenagers in a randomized
      trial. We propose to compare care in nine Close To Home Centers with Automated Risk Appraisal
      for Adolescents/Telephone Support (RA/TS) compared to usual care plus mailed screening
      results (UC+). Each site will be randomly assigned to start with six months on RA/TS or six
      months on UC+ and follow with the alternative in a crossover design. RA/TS is a web-based
      screening and assessment tool completed by adolescents during primary care visits and a
      linked, structured telephone tracking intervention consisting of three follow-up telephone
      calls to youth and their families monitoring identified problems and barriers to services.
      Specifically, we aim to:

        1. compare frequency of problem drug use and abuse identification in RA/TS youth vs. youth
           in usual care (UC+);

        2. examine frequency of counseling, referral, psychotropic medication or other
           interventions for youth screening positive for problem drug use and abuse on RA (Risk
           Appraisal) in RA/TS youth vs. UC+ youth; and

        3. evaluate the effects of the TS (Telephone Support) program on return to primary care,
           likelihood of completing referrals, number of primary care visits, number of specialty
           visits, and satisfaction with services after four months for youth screening positive
           for problem drug use and abuse.
    

Intervention name(s): Telephone case management and motivational interviewing; Usual care
Intervention type(s): Behavioral; Behavioral
Intervention description(s): 'Telephone case management and motivational interviewing': Immediate screening results are given to the physician during the patient's visit. Telephone case management and motivational interviewing (MI) at 1, 6, and 9 weeks to enhance engagement and commitment to change; Usual care with mailed screening results
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Primary purpose: Screening