Intervening with at-risk adolescents shows long-term benefits

Kaiser Permanente study followed teens’ substance use, mood disorders for 7 years after brief intervention, referral to treatment

 

By Jan Greene

A long-term Kaiser Permanente study following 1,851 adolescents who reported substance use or mood problems at a pediatric clinic found those who had access to a brief intervention and referral to treatment were less likely to have a related diagnosis 7 years later, in their 20s.

Stacy Sterling, DrPH, MSW

The findings, published in the Journal of Adolescent Health, echo similar results from the same group of young people at 1 year and at 3 years after their clinic visits. Those who received the intervention were less likely to have a substance use disorder or inpatient hospitalization as young adults.

“For the first time we’ve been able to look at outcomes among young adults, well after an intervention was delivered in pediatric primary care,” said lead author Stacy Sterling, DrPH, MSW, a research scientist with the Kaiser Permanente Division of Research who co-leads its Center for Addiction and Mental Health Research. “Our findings are encouraging, as they document positive results related to the development of future disorders well into young adulthood.”

Sterling’s research group is studying a 3-part process known as SBIRT: screening, brief intervention, and referral to treatment. The brief intervention involves a patient-centered conversation between a clinician and patient using motivational interviewing techniques. Patients with more severe symptoms may be referred to specialty mental health or addiction medicine treatment.

The team carried out a pragmatic clinical trial between 2011 and 2013 with 1,851 adolescents who were treated at a Kaiser Permanente Northern California general pediatrics clinic. In this study, the researchers compared the patients in the SBIRT arm to those in usual care and followed their progress for 7 years, until they were aged 21 to 28.

When looking at the patients as young adults, the investigators found the SBIRT group had lower odds of any substance use disorder diagnosis and lower odds of inpatient hospitalizations and fewer psychiatry visits compared with those who had usual care. About a fifth of those receiving the intervention (19%) had a substance use diagnosis, compared with 24% of those who did not.

 

We’ve shown that SBIRT is an important and effective prevention and early intervention approach which can produce better outcomes and reduce avoidable health care utilization, with lasting effects into young adulthood.

Stacy Sterling, DrPH, MSW

 

“As most adult substance use disorders originate in adolescence, this is the ideal time to intervene to prevent adolescent use entirely or prevent mild problems from progressing,” the authors wrote. “We found benefits to the SBIRT group even after 7 years, which makes a strong case for making adolescent screening and subsequent brief interventions, when needed, an important vital sign metric during well-check visits in this group.”

Risky transition to adult care

Reaching adolescents at risk is particularly important, Sterling said, because young adults can often fall through the cracks of the health care system when they transition away from pediatric care and sometimes lose health insurance coverage. “We’ve shown that SBIRT is an important and effective prevention and early intervention approach which can produce better outcomes and reduce avoidable health care utilization, with lasting effects into young adulthood,” she said.

The analysis also looked at different subgroups in the sample and found that among Hispanic teens, those in the SBIRT group had lower odds of any drug and marijuana use disorder diagnoses as young adults compared with usual care. Among Black teens, those in the SBIRT group had lower odds of alcohol use disorder diagnoses as young adults than those who received usual care. This is one of the few studies to examine outcomes specifically among these important populations, Sterling said.

The lingering effects of pediatric intervention into young adulthood is good news for clinicians, said co-author Katrina Saba, MD, a pediatrician with The Permanente Medical Group. “For those of us who take care of adolescents, the findings of this study are exciting,” Saba said. “It is powerful to see that the intervention we make during our patients’ health care visit can improve their health outcomes 7 years later.”

The study was funded by the National Institute on Alcohol Abuse and Alcoholism and the Conrad N. Hilton Foundation.

Co-authors also included Andrea Kline-Simon, MS, Sujaya Parthasarathy, PhD, Constance Weisner, DrPH, MSW, and Verena Metz, PhD, of the Division of Research; Ashley Jones, PsyD, of Kaiser Permanente Addiction Medicine and Recovery Services; and Lauren Hartman, MD, formerly of The Permanente Medical Group.

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About the Kaiser Permanente Division of Research

The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of illness and well-being, and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 600-plus staff is working on more than 450 epidemiological and health services research projects. For more information, visit divisionofresearch.kaiserpermanente.org or follow us @KPDOR.

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