Well-Child Screening and Referral to Prevent Alcohol Use Before High School

Project Abstract Recent attempts to improve early screening and referral for prevention (SRP) of alcohol use (AU) and alcohol use disorders (AUD) during general practitioner check-ups, emergency room visits, and other medical services have been challenging, because they have not been efficacious; their dissemination and adoption by practitioners have been minimal; and they have failed to increase intervention enrollment over care-as-usual, which is 15% at best. In contrast, the tools and protocol proposed in this project were specifically designed for screening of risk for AU by 9-13 year-olds; designed to prevent or curb any substance use before high school; developed collaboratively with pediatricians for use during well-child, check-up appointments at their practices; created so it can be implemented by other health care providers such as behavior specialists or pediatric nurses, and not just by pediatricians; and has led over 80% of parents of high-risk youth from low-resource, urban communities to enroll into family-based preventive interventions (over 90% of whom completed the intervention). This SRP protocol developed in basic research studies addresses historical barriers to pediatricians’ use of screening tools that target AU, and has high acceptability among children, parents, and pediatric health care staff. This Phase 1 proposal and the planned Phase 2 activities will prepare the SRP for commercialization in collaboration with pediatricians (working in urban practices in Cleveland, Ohio, Chapel Hill, North Carolina, and Miami, Florida) who represent the anticipated early adopters. The first aim is to edit and enhance iRT’s existing native pediatric screening app to include the parent-report, Parent Evaluation Risk Index (PERI), and the youth self-report, Youth Risk Index (YRI), tools, so that they are accessible for completion on a native app (offline mobile devices such as tablets that do not have internet connectivity), and are integrated into an electronic health record (EHR). Both Usability Studies, as well as a Feasibility and Acceptance Study, will result in benchmark evaluations to inform the submission of a Phase 2 application. If feasible, then Phase 2 activities will include the creation of “out-of-the-box” technological solution that will be scalable and accessible for use in busy pediatric practices.NARRATIVE About 1/3 of U.S. citizens experience Alcohol Use Disorders (AUD) in their lifetime and underage AU costs $61.9 billion annually. The main goal of this Phase 1 project is to create and test the feasibility of using a Safer Adolescence Screening App (SASA) during well-child check-ups at pediatricians’ offices for completion by both parents and their 9- to 13-year old children as part of a Screening and Referral for Prevention (SRP) protocol. In a randomized trial of these screening tools, over 75% of all parents of at-risk youth completed an assessment and 45% sought out further intervention; thus, by the end of a Phase 2 project, this team will have completed the creation of an “out-of-the-box” SRP protocol that will be scalable and accessible for use by pediatricians and other allied health care professionals to align with the needs of their busy pediatric offices and professions.