Virtual Screening and Intervention for Adolescent Alcohol Use

Overseen By Stacy A Sterling, DrPH, MSW

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: Kaiser Permanente

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 2

22320 Participants Needed

Trial Summary

Do I need to stop my current medications to join the trial?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Centralized Virtual SBIRT for adolescent alcohol use?

Research suggests that the SBIRT model, which includes screening, brief intervention, and referral to treatment, may be effective for adolescents at risk of substance use disorders. Although more studies are needed, brief interventions have shown promise in helping adolescents reduce risky substance use behaviors. ^{1 2 3 4 5}

Is the SBIRT approach safe for adolescents?

The SBIRT approach, which includes screening, brief intervention, and referral to treatment, is widely used and considered safe for adolescents. It is an evidence-based method aimed at reducing substance use and preventing related health issues. ^{4 5 6 7 8}

How is the Centralized Virtual SBIRT treatment different from other treatments for adolescent alcohol use?

Centralized Virtual SBIRT is unique because it uses telehealth to deliver screening, brief intervention, and referral to treatment for adolescents, which can reduce the burden on on-site clinicians and make the process more accessible and sustainable compared to traditional in-person methods. ^{1 2 5 9 10}

What is the purpose of this trial?

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.

Eligibility Criteria

This trial is for adolescents who may be at high or severe risk of alcohol or other drug use disorders. It's aimed to help with early identification and treatment, including those with comorbid mental health issues.

Inclusion Criteria

I am a teenager at risk of substance use disorder, showing signs of depression or suicidal thoughts.

Exclusion Criteria

I am an adolescent and have had a recent Well Visit.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1 week

1 visit (virtual)

Intervention

Brief interventions delivered virtually by video or telephone by a centralized behavioral health clinician

2 years

Multiple visits (virtual)

Follow-up

Participants are monitored for AOD use, mental health diagnoses, and health services utilization

2 years

1- and 2-year follow-up visits

Treatment Details

Interventions

• Centralized Virtual SBIRT

Trial Overview The study is testing a centralized virtual SBIRT (Screening, Brief Intervention, and Referral to Treatment) approach in pediatric primary care settings to see if it can effectively identify and manage adolescent substance use.

Participant Groups

Group I: CV SBIRT Experimental Treatment 1 Intervention

Clinics where brief interventions are delivered virtually by video or telephone by a centralized behavioral health clinician (CV-SBIRT arm)

Group II: Usual Care/Traditional SBIRT Active Control 1 Intervention

Clinics where appointment-based brief interventions are delivered by a behavioral health clinician assigned to the clinic (Traditional SBIRT arm)

Centralized Virtual SBIRT is already approved in United States for the following indications:

Approved in United States as SBIRT for:

• Alcohol use disorder
• Substance use disorder
• Comorbid mental health problems

Who Is Running the Clinical Trial?

Kaiser Permanente

Lead Sponsor

Trials

563

Recruited

27,400,000+

Findings from Research

Adolescent substance use poses significant public health risks, emphasizing the need for healthcare providers, especially pediatricians, to enhance their capabilities in screening and intervening for substance use issues.

The updated clinical report provides a simplified approach to Screening, Brief Intervention, and Referral to Treatment (SBIRT) for adolescents, helping pediatricians implement effective prevention and intervention strategies in various healthcare settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Substance Use Screening, Brief Intervention, and Referral to Treatment. Levy, SJ., Williams, JF.[2022]

The SBIRT (Screening, Brief Intervention, and Referral to Treatment) model is recommended by the American Academy of Pediatrics as an effective approach for pediatricians to address adolescent substance use, which is a significant public health issue.

Research shows that substance use negatively affects the developing brain, highlighting the importance of early screening and intervention; however, comprehensive studies on the combined effectiveness of all SBIRT components in adolescents are still lacking.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Addressing substance misuse in adolescents: a review of the literature on the screening, brief intervention, and referral to treatment model. Beaton, A., Shubkin, CD., Chapman, S.[2022]

In a study of 2252 publicly insured adolescents aged 12-17, 6.8% reported current substance use, with higher rates among non-Hispanic Black adolescents (15.2%) and those with depressive symptoms (14.4%), highlighting the need for effective screening in pediatric care.

Providers identified barriers to implementing SBIRT, such as lack of confidential screening space and referral options, but expressed support for using technology to improve screening and intervention processes, indicating that integrating SBIRT could help address substance use treatment needs in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Addressing adolescent substance use in an urban pediatric federally qualified health center. Yonek, JC., Velez, S., Satre, DD., et al.[2022]

In a study of 1,871 adolescents, the SBIRT (Screening, Brief Intervention, and Referral to Treatment) approach led to fewer psychiatry visits and lower rates of mental health and chronic conditions after one year compared to usual care.

After three years, adolescents receiving SBIRT had fewer total outpatient visits and were less likely to have substance use diagnoses, while also showing an increase in substance use treatment visits, indicating improved health outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Health Care Use Over 3 Years After Adolescent SBIRT. Sterling, S., Kline-Simon, AH., Jones, A., et al.[2020]

The SBIRT model, which includes screening, brief interventions, and referral to treatment, shows promise for identifying and helping adolescents at risk for substance use disorders, based on a review of randomized controlled trials.

Current evidence on the effectiveness of SBIRT for adolescents is limited, highlighting the need for more robust studies with larger sample sizes and longer follow-up periods to better understand its impact in various settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

SBIRT for adolescent drug and alcohol use: current status and future directions. Mitchell, SG., Gryczynski, J., O'Grady, KE., et al.[2022]

In a study involving 2873 adolescents screened for substance use, 52.8% tested positive for alcohol or drug use, highlighting a significant unmet need for treatment in this population.

The implementation of the SBIRT program faced barriers such as adaptability, complexity, and staff turnover, suggesting that future efforts should focus on improving integration into clinical workflows and securing necessary funding.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implementing SBIRT for adolescents within community mental health organizations: A mixed methods study. Stanhope, V., Manuel, JI., Jessell, L., et al.[2020]

A review of 7 randomized controlled trials in emergency departments found that while some interventions using SBIRT showed significant effects on risky drinking among adolescents, no single intervention effectively reduced both alcohol consumption and related consequences.

Interestingly, the process of screening and the experience of receiving emergent care may have a protective effect on alcohol use, as five studies indicated positive outcomes for all participants, regardless of the intervention condition.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Screening, brief intervention, and referral for alcohol use in adolescents: a systematic review. Yuma-Guerrero, PJ., Lawson, KA., Velasquez, MM., et al.[2022]

Advanced practice registered nursing (APRN) students showed significant improvements in their self-reported competence and confidence in delivering adolescent SBIRT (screening, brief intervention, and referral to treatment) after participating in a comprehensive training program, with results indicating a p-value of less than 0.001.

The successful integration of adolescent SBIRT into the nursing curriculum suggests that this evidence-based approach can effectively prepare future healthcare providers to address adolescent substance use issues in routine health care settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Preparing Advanced Practice Registered Nursing Students to Deliver Adolescent SBIRT for Substance Use. Kuzma, EK., Boucher, N., Gray, B., et al.[2019]

The Remote Brief Intervention and Referral to Treatment (R-BIRT) model was found to be feasible, with a 40% acceptance rate among 125 eligible emergency department patients, indicating potential for wider implementation.

Patients who received consultations during their emergency department visit had a significantly higher completion rate of 90% compared to only 10% for those contacted after their visit, suggesting that immediate intervention may enhance engagement in treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The remote brief intervention and referral to treatment model: Development, functionality, acceptability, and feasibility. Boudreaux, ED., Haskins, B., Harralson, T., et al.[2018]

A study involving 144 undergraduate nursing students demonstrated that an interactive computer simulation for adolescent SBIRT significantly improved students' self-perceived competence, confidence, and readiness to deliver substance use interventions, with statistically significant results (p < 0.05).

The positive feedback from students regarding the simulation experience highlights the effectiveness of using technology-based training methods in nursing education, suggesting that such simulations can enhance the learning of critical public health interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Interactive Computer Simulation for Adolescent Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Substance Use in an Undergraduate Nursing Program. Burmester, KA., Ahluwalia, JP., Ploutz-Snyder, RJ., et al.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Substance Use Screening, Brief Intervention, and Referral to Treatment. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Addressing substance misuse in adolescents: a review of the literature on the screening, brief intervention, and referral to treatment model. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

Addressing adolescent substance use in an urban pediatric federally qualified health center. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Health Care Use Over 3 Years After Adolescent SBIRT. [2020]

5. United States pubmed.ncbi.nlm.nih.gov

SBIRT for adolescent drug and alcohol use: current status and future directions. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

Implementing SBIRT for adolescents within community mental health organizations: A mixed methods study. [2020]

7. United States pubmed.ncbi.nlm.nih.gov

Screening, brief intervention, and referral for alcohol use in adolescents: a systematic review. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

Preparing Advanced Practice Registered Nursing Students to Deliver Adolescent SBIRT for Substance Use. [2019]

9. Ireland pubmed.ncbi.nlm.nih.gov

The remote brief intervention and referral to treatment model: Development, functionality, acceptability, and feasibility. [2018]

10. United States pubmed.ncbi.nlm.nih.gov

Interactive Computer Simulation for Adolescent Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Substance Use in an Undergraduate Nursing Program. [2022]