Pediatrician-Initiated Screening and Referral to Treatment (Prevention) for 10- to 13-Year-Olds at High Risk for Substance Use Initiation before High School

Introduction: Recent attempts to develop Screening, Brief Intervention, and Referral for Treatment (SBIRT) targeting substance use disorder (SUD) have generated mixed efficacy at best. One barrier to SBIRT success is that patients with “positive” screens fail to enroll in treatment (top enrollment rate=15%). There is potential for SBIRT to employ selective/indicated prevention to deflect the developmental trajectories of youth who are at risk for SUD (e.g., at ages when adults are responsible for enrolling them in intervention). Substance use (SU) initiation before high school is an antecedent to four-fold risk of SUD by age 25. SU initiation before high school also is not rare; 17.3%, 35.8% and 20.0% of 8^th graders have smoked, drank, and used cannabis, respectively.

Methods: This ongoing of the effectiveness of Screening and Referral to Treatment (prevention) (SRT) that begins during pediatrician’s well-child check-ups, is designed for 10- to 13-year-olds who have initiated SU or are at high risk for initiating in the subsequent year, and couples evidence-based screening tools with the Family Check-Up (FCU) prevention program. The partnering clinics serve low-resource, mostly African-American populations in the Pittsburgh, PA region. Evidence that will be reviewed includes acceptability ratings from stakeholders (patients, parents, and pediatricians and their staff); psychometrics and predictive accuracy of the screening tools; enrollment rate of ‘at-risk’ youths and their parents; and efficacy at the half-way point of the study.

Results: To date, 335 patients were screened with 268 scoring “at risk.” Of the at-risk youth randomized into the treatment arm, 74.1% have enrolled and of those, over 90% have completed two or more FCU sessions. Acceptability ratings support the program; e.g., 96.5% of parents reported being happy with or did not mind the screening and 98.2% of parents stated they would or probably would seek help if their child was “at risk” and the pediatrician knew someone who could help. Regarding efficacy, crude intent-to-treat, ANCOVA preliminary results were consistent with hypothesized FCU outcomes, including statistical reductions in youth irritability and violence exposure (both p<.05) and trends in reduced conduct disorder behaviors, tobacco and cannabis initiation, parental permissiveness, and family conflict.

Conclusions: Much greater engagement into prevention of at-risk families occurs with pediatrician-initiated SRT than alternative healthcare venues to date. SRT provides a means for collaborating with pediatricians to conduct SU prevention programs. Specific roles in the SRT protocol could be filled by professionals within the American Medical Association’s newly approved addiction medicine specialist.