Intervention, Referrals Lead To Reduced Health Care Needs For Adolescents With Substance Abuse Disorders

Intervention, referrals lead to reduced health care needs for adolescents with substance abuse disorders

Kaiser Permanente researchers find long-term benefits for patients and health systems

By Jon Weiner

Screenings, interventions, and referrals can help adolescent teens overcome substance abuse in the short-term. Less is known about the long-term effects of those efforts. A new study from Kaiser Permanente, published in the April 24 issue of the journal Pediatrics, suggests that the benefits can last for many years and can include sustained reductions in mental health conditions.

Lead author, Stacy Sterling, DrPH, MSW

In a new study titled, “Health Care Utilization over 3 Years after Adolescent SBIRT,” researchers led by Stacy Sterling, DrPH, MSW, of the Kaiser Permanente Northern California Division of Research, found that adolescents with access to screening, brief intervention, and referral to treatment (SBIRT) were less likely to have mental health or chronic medical conditions after 1 year.

Substance abuse is “closely associated with the top 3 causes of mortality and morbidity among adolescents – injuries, suicide and homicide,” write the authors. And, they note, adolescent substance use often goes hand-in-hand with other medical and mental health conditions and can lead to higher use of health care services.

In this new study, they found that those with access to SBIRT services had fewer psychiatry visits over 1 and 3 years, and fewer total outpatient visits at 3 years, leading to lower costs and utilization of health care.

“The fact that we saw a difference in substance use problems even 3 years out was surprising,” said Sterling, the study’s lead author. “It suggests that providing access to SBIRT may plant a seed for patients and their care teams, creating awareness about substance use that may help kids avoid future problems.”

The study used electronic health record data to examine how much health care was used among adolescents with access to SBIRT services, from a randomized clinical trial that compared usual care to 2 other methods of delivering SBIRT in pediatric primary care: delivered by a pediatrician or by an embedded behavioral clinician.

The study was conducted at Kaiser Permanente Northern California (KPNC), an integrated health care delivery organization. The sample was taken from the pediatrics department in Oakland, California and consisted of 1,871 adolescents ages 12 to 18.

“We found that adolescents with access to SBIRT services, regardless of whether it was through their pediatrician or an embedded behavioral health clinician, were less likely to have mental health or chronic medical conditions after 1 year,” Sterling said. “We also found that SBIRT likely leads to lower health care utilization.”

The authors suggest that pediatric primary care and adolescent medicine clinics should consider implementing SBIRT, whether through training pediatricians or embedding SBIRT-trained behavioral health clinicians (or both) into the care team. Increased attention, training, and capacity to address substance use and other behavioral health problems can have a significant impact on future health problems and health care use.

“We need to increase resources and focus on the role of behavioral health on the overall health and well-being of children and teenagers in our care,” added Sterling. “I think more research is needed on SBIRT and these important, long-term health impacts.”

The National Institute on Alcohol Abuse and Alcoholism funded the study.

Sterling’s co-authors included Andrea Kline-Simon, Ashley Jones, PsyD, Constance Weisner, DrPH, MSW, and Sujaya Parthasarathy, PhD, all of the Division of Research; and Lauren Hartman, MD, and Katrina Saba, MD, of The Permanente Medical Group.

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