Shannon Gwin Mitchell1, Robert P Schwartz2, Arethusa S Kirk3, Kristi Dusek2, Marla Oros4, Colleen Hosler4, Jan Gryczynski2, Carolina Barbosa5, Laura Dunlap6, David Lounsbury7, Kevin E O'Grady8, Barry S Brown9. 1. Friends Research Institute, Baltimore, MD USA. Electronic address: smitchell@friendsresearch.org. 2. Friends Research Institute, Baltimore, MD USA. 3. Total Health Care, Baltimore, MD USA. 4. Mosaic Group, Baltimore, MD USA. 5. RTI International, Chicago, IL USA. 6. RTI International, Research Triangle Park, NC USA. 7. Yeshiva University, Bronx, NY USA. 8. University of Maryland, College Park, Department of Psychology, College Park, MD USA. 9. Friends Research Institute, Baltimore, MD USA; University of North Carolina at Wilmington, Wilmington, NC USA.
Abstract
BACKGROUND: Alcohol, tobacco, and other drug use remains highly prevalent among US adolescents and is a threat to their well-being and to the public health. Evidence from clinical trials and meta-analyses supports the effectiveness of Screening, Brief Intervention and Referral to Treatment (SBIRT) for adolescents with substance misuse but primary care providers have been slow to adopt this evidence-based approach. The purpose of this paper is to describe the theoretically informed methodology of an on-going implementation study. METHODS: This study protocol is a multi-site, cluster randomized trial (N=7) guided by Proctor's conceptual model of implementation research and comparing two principal approaches to SBIRT delivery within adolescent medicine: Generalist vs. Specialist. In the Generalist Approach, the primary care provider delivers brief intervention (BI) for substance misuse. In the Specialist Approach, BIs are delivered by behavioral health counselors. The study will also examine the effectiveness of integrating HIV risk screening within an SBIRT model. Implementation Strategies employed include: integrated team development of the service delivery model, modifications to the electronic medical record, regular performance feedback and supervision. Implementation outcomes, include: Acceptability, Appropriateness, Adoption, Feasibility, Fidelity, Costs/Cost-Effectiveness, Penetration, and Sustainability. DISCUSSION: The study will fill a major gap in scientific knowledge regarding the best SBIRT implementation strategy at a time when SBIRT is poised to be brought to scale under health care reform. It will also provide novel data to inform the expansion of the SBIRT model to address HIV risk behaviors among adolescents. Finally, the study will generate important cost data that offer guidance to policymakers and clinic directors about the adoption of SBIRT in adolescent health care.
RCT Entities:
BACKGROUND:Alcohol, tobacco, and other drug use remains highly prevalent among US adolescents and is a threat to their well-being and to the public health. Evidence from clinical trials and meta-analyses supports the effectiveness of Screening, Brief Intervention and Referral to Treatment (SBIRT) for adolescents with substance misuse but primary care providers have been slow to adopt this evidence-based approach. The purpose of this paper is to describe the theoretically informed methodology of an on-going implementation study. METHODS: This study protocol is a multi-site, cluster randomized trial (N=7) guided by Proctor's conceptual model of implementation research and comparing two principal approaches to SBIRT delivery within adolescent medicine: Generalist vs. Specialist. In the Generalist Approach, the primary care provider delivers brief intervention (BI) for substance misuse. In the Specialist Approach, BIs are delivered by behavioral health counselors. The study will also examine the effectiveness of integrating HIV risk screening within an SBIRT model. Implementation Strategies employed include: integrated team development of the service delivery model, modifications to the electronic medical record, regular performance feedback and supervision. Implementation outcomes, include: Acceptability, Appropriateness, Adoption, Feasibility, Fidelity, Costs/Cost-Effectiveness, Penetration, and Sustainability. DISCUSSION: The study will fill a major gap in scientific knowledge regarding the best SBIRT implementation strategy at a time when SBIRT is poised to be brought to scale under health care reform. It will also provide novel data to inform the expansion of the SBIRT model to address HIV risk behaviors among adolescents. Finally, the study will generate important cost data that offer guidance to policymakers and clinic directors about the adoption of SBIRT in adolescent health care.
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Authors: Jan Gryczynski; Shannon G Mitchell; Robert P Schwartz; Sharon M Kelly; Kristi Dušek; Laura Monico; Kevin E O'Grady; Barry S Brown; Marla Oros; Colleen Hosler Journal: J Adolesc Health Date: 2018-12-18 Impact factor: 5.012
Authors: Carolina Barbosa; Brendan Wedehase; Laura Dunlap; Shannon Gwin Mitchell; Kristi Dusek; Robert P Schwartz; Jan Gryzcynski; Arethusa S Kirk; Marla Oros; Colleen Hosler; Kevin E O'Grady; Barry S Brown Journal: J Stud Alcohol Drugs Date: 2018-05 Impact factor: 2.582
Authors: Laura B Monico; Shannon Gwin Mitchell; Kristi Dusek; Jan Gryczynski; Robert P Schwartz; Marla Oros; Colleen Hosler; Kevin E O'Grady; Barry S Brown Journal: J Adolesc Health Date: 2019-03-06 Impact factor: 5.012
Authors: Carolina Barbosa; Alexander Cowell; Laura Dunlap; Brendan Wedehase; Kristi Dušek; Robert P Schwartz; Jan Gryczynski; Alan Barnosky; Arethusa S Kirk; Marla Oros; Colleen Hosler-Moore; Kevin E O'Grady; Barry S Brown; Shannon Gwin Mitchell Journal: J Stud Alcohol Drugs Date: 2022-03 Impact factor: 2.582
Authors: Shannon Gwin Mitchell; Jan Gryczynski; Robert P Schwartz; Arethusa S Kirk; Kristi Dusek; Marla Oros; Colleen Hosler; Kevin E O'Grady; Barry S Brown Journal: J Subst Abuse Treat Date: 2020-01-20
Authors: Karen S Calabro; Salma K Marani; Thuan A Le; Georges E Khalil; Irene M Tami-Maury; Alexander V Prokhorov Journal: Health Serv Res Manag Epidemiol Date: 2017-05-02