title: SBIRT Implementation for Adolescents in Urban Federally Qualified Health Centers.
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.
  
  
  CONCLUSIONS
  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.
authors: Friends Research Institute, Baltimore, MD USA. Electronic address: smitchell@friendsresearch.org.
authors: Shannon Gwin
authors: SG
authors: Mitchell
authors: Friends Research Institute, Baltimore, MD USA.
authors: Robert P
authors: RP
authors: Schwartz
authors: Total Health Care, Baltimore, MD USA.
authors: Arethusa S
authors: AS
authors: Kirk
authors: Friends Research Institute, Baltimore, MD USA.
authors: Kristi
authors: K
authors: Dusek
authors: Mosaic Group, Baltimore, MD USA.
authors: Marla
authors: M
authors: Oros
authors: Mosaic Group, Baltimore, MD USA.
authors: Colleen
authors: C
authors: Hosler
authors: Friends Research Institute, Baltimore, MD USA.
authors: Jan
authors: J
authors: Gryczynski
authors: RTI International, Chicago, IL USA.
authors: Carolina
authors: C
authors: Barbosa
authors: RTI International, Research Triangle Park, NC USA.
authors: Laura
authors: L
authors: Dunlap
authors: Yeshiva University, Bronx, NY USA.
authors: David
authors: D
authors: Lounsbury
authors: University of Maryland, College Park, Department of Psychology, College Park, MD USA.
authors: Kevin E
authors: KE
authors: O'Grady
authors: Friends Research Institute, Baltimore, MD USA; University of North Carolina at Wilmington, Wilmington, NC USA.
authors: Barry S
authors: BS
authors: Brown
mesh_terms: D000293:Adolescent; D015142:Baltimore; D003695:Delivery of Health Care / Q000379:methods*; D006302:Health Services Research; D006801:Humans; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care / Q000379:methods*; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000628:therapy*; D014505:Urban Population
keywords: Adolescents; Brief intervention; Implementation; Primary care; SBIRT