Readiness Among Pediatric Health Professionals for Screening, Brief Intervention and Referral to Treatment (SBIRT) Targeting Adolescent Risky Behaviors in North Carolina and Potential Associated Healthcare Savings

Background: Recent collaborations between prevention scientists and pediatricians have advanced SBIRT to prevent adolescent risky behaviors. Barriers to dissemination and sustainability of these SBIRT programs are unknown. Implementation of SBIRT services is more likely if they could yield short-term cost savings to providers or third-party payers. Methods: Stratified sampling of members from state professional North Carolinian organizations yielded surveys from pediatricians (N=151) and licensed marriage and family therapists (N=231) regarding barriers and facilitators of these SBIRT programs. To estimate healthcare costs associated with adolescents’ risky behaviors (ages 9-17), the 2012 fiscal year Healthcare Cost and Utilization Project (H-CUP) databases of North Carolina were analyzed. Costs were estimated for medical charges associated with ICD-9 codes (any of the 1^st 3 codes per service) that directly indicate (e.g., alcohol-related disorders) or often stem from (e.g., HIV infection) risky behaviors. Results: 99% of pediatricians reported that “some” to “nearly all” patients would benefit from the SBIRT, 67% would use it universally, and 27% would use it with “patients who seemed to need it.” Their most frequent barriers were time required (69%), anticipated parental unacceptance (20%), and lack of insurance coverage (12%). Their most frequent facilitators were a simple, streamlined screening (65%); pre-established referral network (22.5%); and reimbursement for services (13%). 87% of family therapists would accept referrals from pediatricians. They have training and experience working with such families, as a mean 45% (SD=33%) of their clients receive therapy for their children’s behavior problems. Family therapists’ most common barriers were limitations to service capacity (30%) and insurance coverage (26%); their facilitators were additional training (37%) and needing a referral network (23%). In 2012, 34% of adolescent inpatient hospital visits, 7% of adolescent outpatient hospital visits, and 8% of adolescent emergency department visits were associated with a risky behavior. Inpatient hospital ($121M), outpatient hospital ($67M) and emergency department charges ($85M) in 2012 that related to adolescent risky behaviors were approximately $273M overall. Conclusions: North Carolinian pediatricians are largely prepared to implement an SBIRT that could fit within their practices’ “flow” and family therapists are willing to accept their referrals. Additional training, funding for services, and referral networks are needed by many pediatricians and therapists to make an SBIRT feasible. There are potentially hundreds of millions in healthcare costs that could be saved by preventing or curbing adolescent risky behaviors in North Carolina alone.