Clinical Decision Supports to Prevent Teen Substance Use in Pediatric Primary Care

PROJECT SUMMARY
Improving the reach and adoption of evidence-based prevention programming is a top priority for substance use prevention science. In the U.S., complex interactions between social and environmental factors and broader structural conditions contribute to differences in substance use-related health outcomes. Prior research has produced numerous evidence-based substance use prevention interventions, including several that are family-focused. Family-focused programs promote protective parenting skills—such as warmth, parental monitoring, and positive discipline—to reduce substance use risk in adolescents. Although effective, family-focused programs have limited reach among communities served by federally qualified health centers. Integrating family-focused programs into existing healthcare infrastructures can help overcome these challenges. Federally qualified health centers (FQHCs) deliver primary care to over 30 million patients nationwide and are well-positioned to expand the adoption and reach of family-focused prevention programs. We propose one of the first studies to co-design (R61) and test (R33) a novel implementation strategy to Support Pre-Adolescents and families’ linkage to substance use pRevention services in primary Care (SPARC). Partnering with caregivers, clinicians, FQHC leaders, and a statewide nonprofit organization that supports FQHC capacity in Connecticut, this study will take place at a large FQHC serving more than 18,000 children in New Haven, CT. The study brings together an interdisciplinary team with expertise in adolescent substance use prevention, implementation research, health services research, and clinical informatics. SPARC will include a co-designed clinical recommendation, clinical decision support tool, and referral process to link caregivers of 9–12-year-old primary care patients to a locally delivered family-focused substance use prevention program, Guiding Good Choices. Guiding Good Choices has demonstrated effectiveness in preventing adolescent substance use by strengthening protective parenting skills. Guided by the Consolidated Framework for Implementation Research and RE-AIM frameworks, during the R61 Planning Phase, we will iteratively develop the SPARC implementation strategy with input from multiple stakeholder groups (R61 Aim 1) and evaluate its usability, acceptability, and feasibility in routine clinical settings (R61 Aim 2). Upon successful completion of R61 milestones, we will examine SPARC’s impact on Guiding Good Choices adoption and reach through a pragmatic randomized controlled trial of clinicians (R33 Aim 1). We will also examine organizational, clinician-level (R33 Aim 2), and caregiver-level (R33 Aim 3) factors associated with variation in adoption and reach. Completion of the proposed studies will inform future efforts to expand the delivery of evidence-based substance use prevention programs across FQHC settings.

Grant Number: 5R61DA062103-02
NIH Institute/Center: NIH
Principal Investigator: Deepa Camenga