Two to three brief training sessions can significantly increase pediatricians’ use of screening and brief interventions to help their patients with substance use and mental health problems, according to a large, 2-year trial supported by NIAAA. The study also found that pediatric practices can increase delivery of these services by adding behavioral health clinicians to their teams.

Mounting evidence supports the use of screening, brief intervention, and referral to treatment (SBIRT) in pediatric practices to reduce underage drinking and its harmful consequences. Pediatricians often report barriers to conducting SBIRT, however, including time constraints and a lack of training.

Researchers at Kaiser Permanente Northern California compared two practical ways to overcome these barriers and increase the delivery of SBIRT services in a trial involving about 50 pediatricians and 1,900 adolescents. One group of pediatricians was offered three 60-minute SBIRT training sessions then encouraged to conduct assessments and brief interventions when needed. A second group had one 60-minute training session, then was encouraged to assess and refer patients as needed for interventions by clinical psychologists “embedded” in their practices. For comparison, a third, “usual care” group had access to the same clinical guidelines and tools but no SBIRT training or psychologists in their practices.

The researchers found that, following SBIRT training, the pediatrician-only group was about 10 times more likely to conduct brief interventions with patients deemed at risk, compared with usual care pediatricians (16 percent for the trained group vs. 1.5 percent for usual care). In the pediatrician-plus-psychologist group, 24 percent of at-risk patients received brief interventions.

Although overall pediatrician attention to behavioral health concerns was still low following training, the researchers indicated that embedding behavioral health clinicians in primary care could be a cost-effective way to increase SBIRT delivery. Future analyses will examine patient outcomes and the cost-effectiveness of the two SBIRT delivery options.

Source:

Sterling, S.; Kline-Simon, A.H.; Satre, D.D.; Jones, A.; Mertens, J.; Wong, A.; and Weisner, C. Implementation of screening, brief intervention, and referral to treatment for adolescents in pediatric primary care: A cluster randomized trial. JAMA Pediatrics 169(11):e153145, 2015. PMID: 26523821

 

Reprinted from the NIAAA Spectrum, Volume 8, Issue 1, February 2016.