1. Adolescent SBIRT implementation: Generalist vs. Specialist models of service delivery in primary care
- Author
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Barry S. Brown, Robert P. Schwartz, Colleen Hosler, Arethusa Kirk, Marla Oros, Jan Gryczynski, Kristi Dusek, Kevin E. O'Grady, and Shannon Gwin Mitchell
- Subjects
Adult ,medicine.medical_specialty ,Tobacco use ,Adolescent ,Substance-Related Disorders ,Service delivery framework ,Psychological intervention ,Medicine (miscellaneous) ,Primary care ,Generalist and specialist species ,Article ,Health services ,medicine ,Humans ,Mass Screening ,Child ,Referral and Consultation ,Primary Health Care ,business.industry ,Psychiatry and Mental health ,Clinical Psychology ,Family medicine ,Pshychiatric Mental Health ,Brief intervention ,Substance use ,business ,Delivery of Health Care - Abstract
BACKGROUND: Drug, alcohol, and tobacco use among adolescents pose significant short- and long-term health consequences and are associated with more severe use as adults. Screening, brief intervention, and referral to treatment in primary care settings has the potential to deliver preventive interventions to a diverse range of adolescents, but optimal implementation of these services needs to be determined. The purpose of this study was to compare implementation of two different SBIRT service delivery models in primary care settings. METHODS: This cluster-randomized trial assigned 7 primary care clinics of a federally qualified health center to implement brief interventions (BI) using a Generalist model (4 sites), in which BIs were delivered by the primary care provider (PCP), or a Specialist model (3 sites), in which BIs were delivered by a behavioral health counselor (BHC) for adolescent patients ages 12–17 years. Implementation was tracked through the clinic’s electronic health record, spanning 9,639 clinic visits over 20 months. Multilevel logistic regression modeling was used to compare Generalist and Specialist strategies on penetration of BI for patients scoring ≥2 on the CRAFFT substance use screen, delivered by the PCP in the Generalist sites, and via warm hand-off to a BHC in the Specialist sites. RESULTS: Approximately 62% of adolescent patient visits were screened with the CRAFFT (with
- Published
- 2020
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