Two to three brief training sessions can significantly increase pediatricians’ use of techniques for identifying and treating young people with potential alcohol, substance use, and mental health problems, according to a new study in a large pediatric primary care clinic. Collectively known as screening, brief intervention, and referral to treatment (SBIRT), such techniques could be important tools for preventing and treating these common problems among young people. The study also found that pediatric practices can improve support for patients who need these services by adding behavioral health clinicians to their teams. A report of the study, which was funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health, is now online in JAMA Pediatrics.
“This research provides valuable new information about strategies that might improve implementation of SBIRT in everyday pediatric practice settings,” says NIAAA Director George F. Koob, Ph.D.
Underage drinking and drug use, which often coexist with mental health problems, are common and dangerous. Risks of heavy drinking in adolescence, for example, range from injuries and school troubles to long-lasting brain changes and dependence.
Research has shown that primary care physicians who conduct SBIRT with adult patients can reduce heavy drinking, its harmful consequences, and related health care costs. In recent years, mounting evidence has supported the use of SBIRT by primary care pediatricians to prevent substance use problems from starting or escalating in their young patients. However, physicians often face barriers to providing these services, including time constraints and a lack of training in SBIRT.
The new study, led by Stacy Sterling, Dr.P.H.(c.), M.S.W. at Kaiser Permanente Northern California in Oakland, compared practical ways to overcome both barriers in a general pediatric care clinic.
In a two-year trial that involved nearly 50 pediatricians and about 1,900 adolescents, researchers measured SBIRT use among three groups of clinicians.
“A ‘pediatrician-only’ group was offered three 60-minute SBIRT training sessions,” explains Ms. Sterling. “In the clinic, this group was then expected to conduct full SBIRT assessments and brief interventions by themselves as needed.”
A second group of pediatricians had one 60-minute training session. In the clinic, this group was expected to assess patients and refer them as needed to clinical psychologists who had been “embedded” into the practices to conduct interventions.
A “usual care” group of pediatricians served as controls. They had access to the same clinical guidelines and tools, but did not take part in SBIRT training or have embedded clinical psychologists in their practices.
The researchers found that, following SBIRT training, the pediatrician-only group was about 10 times more likely (16 percent vs. 1.5 percent) to conduct brief interventions with patients deemed at risk, compared with “usual care” pediatricians. In the group of SBIRT-trained pediatricians that worked in-tandem with “embedded” clinical psychologists the brief intervention rate was 24.5 percent, compared with 16 percent in the pediatrician-only group, and 1.5 percent in the usual care group.
“Both intervention arms administered more assessments and brief interventions than those in usual care,” notes Constance Weisner, Dr.P.H., M.S.W., at Kaiser Permanente Northern California in Oakland, and the University of California, San Francisco, the principal investigator of the study. “However, overall pediatrician attention to behavioral health concerns was still low. Embedding non-physician clinicians in primary care could be a cost-effective alternative to pediatricians providing these services, and future analyses of the study data will examine patient outcomes and cost-effectiveness of the two SBIRT modalities.”
