Kaiser Permanente research finds less long-term health care use among at-risk teens when clinicians are specially trained
By Jan Greene
Adolescents who had access to a brief intervention and referral to treatment for substance use or mood problems at a pediatric clinic were less likely to have a related diagnosis 3 years later, new Kaiser Permanente research finds.
In a study published Dec. 28 in the journal Pediatrics, investigators from the Kaiser Permanente Division of Research reported on a pragmatic randomized controlled trial of adolescents who visited a Kaiser Permanente pediatrics clinic between 2011 and 2013. A total of 1,851 patients reported either substance use or mood symptoms in the previous year, and 289 reported both.
The researchers were studying the long-term effectiveness of a three-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 behavioral health treatment.
Of the 289 adolescents who reported both substance use and mood symptoms, 185 were randomized to the SBIRT arm of the study and had access to brief intervention from a pediatrician or clinic-based behavioral health clinician trained in SBIRT. Meanwhile, 104 were randomized to usual care, for which their clinicians had access to screening tools but no formal SBIRT training.
In following their later medical care, the study found that adolescents who had access to SBIRT were half as likely to be diagnosed with depression or a substance use disorder 3 years after screening, and a third less likely to have an emergency department visit.
“These findings are striking, particularly because only about 30 percent of the patients in the SBIRT arm received the brief intervention portion of SBIRT,” said lead author Sujaya Parthasarathy, PhD, a health economist with the Division of Research. “If more of our study sample had a brief intervention, we might have found even greater population effects.”
The adolescents assigned to the study’s SBIRT arm who did not get a formal brief intervention may have benefited in other ways, such as being seen by a pediatrician trained in how to discuss substance use and mental health problems, the authors said. Also, having a behavioral health clinician work in the primary care pediatric clinic could increase awareness of all clinic providers about the need to address mental health issues with their patients.
This study adds additional context to the adolescent SBIRT trial, whose results were initially reported in JAMA Pediatrics in 2015. More recently, in a 2019 Pediatrics article, the study team reported that adolescents who received SBIRT were less likely to have a mental health or chronic medical condition after 1 year.
SBIRT is a technique used in primary care for early intervention with patients who may be having trouble with a substance use or mental health problem to ensure they get the specialized care they need. It is used in both adults and adolescents, though there is a larger evidence base for its use in adults, explained senior author Stacy Sterling, DrPH, MSW, a research scientist at the Division of Research who co-leads its Center for Addiction and Mental Health Research.
“This study reflects experiences from a busy, real-world pediatric clinic, so the results may provide us with a glimpse into SBIRT’s effectiveness in real life,” Sterling said. “SBIRT may be an important early intervention to integrate into pediatric primary care to help head off these problems. If we can identify and implement relatively low-touch, low-cost, and effective early interventions like SBIRT we may be able to significantly impact the well-being of many young people.”
Sterling also noted the results’ relevance for health care systems seeking greater efficiency in identifying behavioral health issues early with a short, simple process that can be easily incorporated into a primary care visit.
“Incorporating behavioral health screening into the teens’ visit allows pediatricians to intervene early and connect the person to appropriate treatment, as opposed to waiting for teens to present to us in a crisis situation,” said co-author Lauren Hartman, MD, an adolescent medicine specialist with The Permanente Medical Group in Oakland. “It allows us to be proactive, as opposed to reactive.”
The study was funded by the National Institute on Alcohol Abuse and Alcoholism.
Co-authors included Andrea H. Kline-Simon, MS, and Constance Weisner, DrPH, MSW, of the Division of Research, and Ashley Jones, PsyD, and Katrina Saba, MD, 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.