Feasibility of Conducting a Brief Screening for Risk of Substance Use before High School in Pediatric Primary Care Settings

Introduction:  Engaging the pediatric medical community in substance use risk reduction and prevention, although mandated within the Affordable Care Act, will require understanding of the patient flow and office activity so that SBIRT can be incorporated into standard operating procedures.  We conducted a feasibility study of the child and parent versions of the screening tool, the “Urgency Indicator” in three pediatric primary care practices within the Children’s Hospital of Pittsburgh network.  

Method:  N=258 records were screened for eligibility and N=106 parent child dyads were recruited by research nurses to complete the screening instruments while waiting for their well-child check-ups with 17 pediatricians within the 3 practices.  The children were between 9 and 12 years of age.  Following informed consent and child assent, the parent was administered the TLI on a laptop computer while the child completed the age-standardized items from the ALEXSA in ACASI format on a separate laptop computer.  Upon completion, the research nurse queried the parent about participating in a follow-up interview at the family’s home or other agreed upon location.  If the parent was in agreement, an appointment with the parent and a research assistant was set for the follow-up.

Results:  The child’s version of the “Urgency Indicator” took an average of 5.34 minutes to complete (range 4.32 to 7.35 minutes) while the parent’s version took an average of 5.67 minutes (range less than 1 to 15.12 minutes).  N=60 child-parent dyads completed the follow-up study, which included ratings of the screening instrument and procedures while waiting to see the doctor.  Overall more than 90% of the parents rated the experience with the screening in the doctors’ office very positively,  with 93.2% expressing they would like their pediatrician to use this kind of screening to identify risk behaviors in their child.   Similarly around 90% of the children found the screening experience to be positive, with 94% of children indicating they think it is important that the pediatrician help kids with risk behaviors.  Pediatricians and office staff were also very positive about the screening procedures and minimal interruption to patient flow.

Discussion:  The “Urgency Indicator” is a brief screening instrument for identifying substance use risk in children that can be quickly administered to families while waiting to visit their pediatrician.