Abstract
Background/Aims We describe findings from a longitudinal study of adolescent substance use (SU) treatment, a web survey of pediatric primary care providers (PCPs), and a pilot study of a Screening, Brief Intervention and Referral to Treatment (SBIRT) model of primary care-based adolescent behavioral healthcare.
Methods The treatment study (N=419) examined pathways to treatment, co-morbidities, and outcomes. The survey (N=437) examined PCP attitudes and knowledge, patient characteristics, and environmental influences, (e.g., mental health parity and medical marijuana laws), and from electronic medical records (EMR), we examined patient demographics, comorbidity, and services utilization. We examined how PCP, panel, and organizational characteristics influence screening practices. The pilot examined whether SBIRT versus usual care increased problem identification and specialty treatment rates, and the feasibility of SBIRT in Pediatrics.
Results Intakes had high levels of medical and psychiatric comorbidities, and frequent primary care visits, but few had SU problems identified or were referred for treatment by PCPs. Integrated treatment produced better short- and long-term outcomes. The survey found that PCPs were less concerned about alcohol and marijuana than other drug use, rated alcohol use as more difficult to discuss (19% v s 15%) or diagnose (56% vs. 70%) than depression, and were more comfortable discussing sexual practices than alcohol (32% vs. 22%). They were more likely to screen boys than girls, with male PCPs even more likely: 23% vs. 6% (p<.0001). Self-reported screening rates were far higher than actual (EMR-documented) rates for all substances. Experience, specialty, and recent AOD training (all p<.05) predicted self-reported rates; only patient age predicted actual rates. Organizational approaches (e.g., EMR tools and workflow guidelines) may matter more than PCP or patient characteristics in determining adolescent alcohol and drug use screening practices. The SBIRT model of care tested in the pilot proved highly feasible. PCPs said that it improved care; more (77) teens were identified and referred for further assessment, and specialty treatment initiation increased from 8.73% to 12% (p<.0001).
Discussion Organizational factors, lack of training, and discomfort with screening may impact adolescent screening and intervention. We discuss the development of integrated models of care for adolescent behavioral healthcare.
