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

PROJECT SUMMARY
In the US, complex interactions between social determinants of health and underlying systems of racism and
discrimination collectively contribute to multiple health inequities associated with substance use. Upstream
prevention efforts can help reduce these inequities. NIDA-funded research has produced numerous evidence-
based substance use prevention interventions, including several that are family-focused. Family-focused
programs promote protective parenting skills––e.g., provision of warmth, parental monitoring, and positive
discipline––to reduce substance use risk in adolescents. Although effective, family-focused programs have
limited reach for low-income families due to multiple structural barriers. Integrating family-focused programs into
existing infrastructures that serve these families can help overcome barriers. Federally qualified health centers
(FQHCs)deliver low-barrier healthcare to30.5 million people (90% of whom live at or below 200% of the Federal
Poverty Level). They are ideally positioned to expandequitable access to family-focused prevention programs.
In
implementation strategy to
response to PAR-24-062,
Support Pre-Adolescents and families' linkage to substance use pRevention services
we propose one of the first studies to co-design (R61) and test (R33) a novel
inprimary Care (SPARC).Partnering with parents (i.e., caregivers), clinicians, FQHC leaders, and a non-profit
dedicated to strengthening FQHCs across CT, thestudy will occur in alarge FQHC that serves >18,000 low-
income children in New Haven, CT. The study brings together a diverse team of experts in adolescent substance
use prevention, implementation science, health equity research, and health informatics. SPARC
co-designed
12-year-old a locally delivered family-focused substance use prevention program,
Guiding Good Choices. Guiding Good Choices has demonstrated effectiveness in preventing adolescent
substance use by improving protective parenting skills. Guided by the Health Equity Implementation Framework,
Consolidated Framework for Implementation Research, and RE-AIM frameworks, during the R61 Planning
Phase, we aim to develop the SPARC implementation strategy with input from diverse stakeholders (R61 Aim
1) and evaluate its usability, acceptability, and feasibility in real-world clinical practice (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 RCT of clinicians (R33 Aim 1). We will also examine organizational, clinician
(R33 Aim 2), and caregiver-level (R33 Aim 3) factors that influence SPARC's adoption and reach. The
engagement of end-users, robust community partnerships, and experts across CT aligns with PAR-24-062's
emphasis on community-driven studies that engage community experts. Completing the proposed studies will
will include a
clinical decision support tool, and referral process to link caregivers of 9 –
patients in primary care to
clinical recommendation,
prepare us to scale evidence-based substance use prevention programs across FQHCs.

Grant Number: 1R61DA062103-01
NIH Institute/Center: NIH
Principal Investigator: Deepa Camenga