Online System for Primary Care to Prevent and Address Teen Substance Use

Substance use usually (90%) begins during adolescence, causing brain and liver damage, risky sexualand driving behavior, and potentially leading to addiction therefore prevention and earlyintervention programs targeting teens are needed to prevent this morbidity, gain productive yearsof life and reduce costs.This proposal presents innovations to overcome the barriers toeffectively addressing teen substance use during primary care visits through furtherdevelopmentof a promising computerized alcohol and substance use computerized Screening and provider BriefAdvice system (cSBA) and integration with an online “clinical processsupport system” calledCHADIS.CHADIS addresses all pediatric screening needs and is currently widely used in pediatricpractice making widespread dissemination of a CHADIS-cSBA module immediately feasible.However,because of limitations related to time and training the approach of motivational interviewing (MI),with strong evidence for effecting behavior change in substance users, was not a part of cSBA.Aninnovation proposed here will take pre-visit teen data related to strengths and goals andacknowledged reasons for usage to populate individualized “teleprompters” accessible at the momentof care by PCP’s along with options for sharing graphical representations for use in reinforcingabstinence or motivate discontinuing usage.In addition, the prompts for discussion of teenidentified strengths and goals will include wording from teen studies using “incremental theory”(orthe belief that people have the potential to change), which has shown result in improvements insocial coping.CHADIS-cSBA will also provide each teen a confidential individualized portalautomatically populated with supports for their endorsed strengths and other supports as well assubstance-related follow-up messaging.Post-visit parent education will include access to a TeenSafe course.Teens found to have serious substance abuse or dual diagnoses will have referralsfacilitated by care coordination functionality.PCP participation will be reinforced by a AmericanBoard of Pediatrics accredited quality improvement program for their required re-certification(MOC-4). In Phase 1, the CHADIS-cSBA module will be created with both professional and teenfeedback and MOC-4 certification obtained.In Phase 2 the resulting system will be piloted; abaseline of substance use screening conducted; then CHADIS-cSBA module will be randomly assigned todoctors and a quality improvement intervention will be conducted to measure reduction in rates ofany substance use at 3 and 12 month follow-up compared to treatment as usual.