Centralized Virtual SBIRT for Pediatric Primary Care
NCT Number: NCT06486688
Status: RECRUITING
Study Type: INTERVENTIONAL
Phases: NA
Conditions: Adolescent Alcohol Use|Mental Health Issue|Alcohol Related Disorders|Adolescents
Interventions: BEHAVIORAL: Centralized Virtual SBIRT
Sponsor: Kaiser Permanente
Sex: ALL
Age: CHILD
Enrollment: 22320
Study Design: Allocation: RANDOMIZED|Intervention Model: PARALLEL|Masking: NONE|Primary Purpose: HEALTH_SERVICES_RESEARCH
Start Date: 2024-02-13
Completion Date: 2027-08-31
Locations: Kaiser Permanente Division of Research, Pleasanton, California, 94588, United States

Summary:
Adolescent alcohol and other drug (AOD) use is a significant public health problem which contributes to high levels of mortality, morbidity and healthcare costs in young people, and identification and early intervention for these problems is critical to improving outcomes. Screening, Brief Intervention and Referral to Treatment (SBIRT) in pediatric primary care is an evidence-based strategy for addressing these problems, but has not been widely and systematically implemented, for a variety of reasons, including lack of training and staffing resources to support its implementation. This pragmatic, Type 1 Hybrid Comparative Effectiveness Implementation study will examine whether a centralized, virtually-delivered modality of SBIRT, rapidly accessible by multiple pediatric primary care clinics, can be cost-effectively implemented to improve early identification and treatment for AOD use and comorbid mental health problems among adolescents identified as being at high or severe risk of AOD use disorder during adolescent Well Visits.

Primary Outcome Measures: Referrals to behavioral health clinicians for SBIRT, Patients seen by behavioral health clinicians in both intervention arms will be determined via appointment codes, During the 2 year intervention period|Brief Interventions, Brief Interventions will be documented in the Electronic Health Record via administrative Z-codes within 1 week of the index screening visit., During the 2-year intervention period|Referrals, Referrals to specialty treatment will be coded using the electronic referral program in the Electronic Health Records within 1 week of the Brief Intervention., During the 2-year intervention period|Specialty Treatment Initiation, Initiation is defined as at least 1 visit to specialty treatment (Addiction Medicine or Child \& Adolescent Psychiatry)., Within 2 months of the index screening visit.|Specialty Treatment Engagement, Engagement is defined as 2 or more specialty treatment encounters., Within 34 days of the initial specialty care initiation encounter.|AOD and Mental Health Diagnoses, Clinical International Classification of Diseases-10 AOD, depression, and anxiety diagnoses, within 1 year and 2 years of the index screening visit|Alcohol and other drug use, Alcohol and other drug use will be measured by the Screening to Brief Intervention (S2BI) screening tool: "In the past year, how many times have you used: alcohol, marijuana (smoked, edible, dabs), tobacco (cigarettes), vaping nicotine, vaping marijuana, other substances?" Responses: never, once or twice, monthly, weekly or more, 1- and 2-year follow-up visits.|Depressive symptoms, Prior two-week depression measures via the Patient Health Questionnaire-2, a validated and commonly used screener for depression: "Over the last 2 weeks how often have you been bothered by the following problems? 1)Little interest or pleasure in doing things; 2) Feeling down, depressed or hopeless?" - Responses: not at all, several days, more than half the days, nearly every day, 1- and 2-year follow-up visits.|Suicidality, Suicidality measured by: Have you thought seriously about killing yourself, made a plan, or tried to kill yourself? Responses: Y/N, 1- and 2-year follow-up visits.|Health Services Utilization, The number of inpatient and Emergency Department encounters, Within 1 year and 2 years of the index screening visit.