(49) Reimagining SBIRT: Provider, Adolescent, and Caregiver Perceptions in Primary Care

Background & Introduction: Screening, brief intervention, and referral to treatment for adolescents (SBIRT-A) is widely recommended by the American Academy of Pediatrics (AAP) to promote detection and early intervention for adolescent alcohol and other drug (AOD) use (Levy et al., 2016). Adolescence is a critical developmental period where AOD use can have significant and negative consequences on long-term health outcomes (Steinfeld & Torregrossa, 2023). Despite this, the level of unmet intervention needs among adolescents with AOD use remains a pressing public health problem. Existing SBIRT-A procedures rely almost exclusively on adolescents alone, despite caregivers being recognized as critical protective factors in adolescent development of AOD use. By involving caregivers, SBIRT-A interventions have the potential to widen the screening net, improve family communication, and strengthen referral to treatment. Early perspectives on different SBIRT components are critical to assessing its effectiveness, and research indicates that providers can reliably self-report and capture the delivery of family-based interventions (Hogue et al., 2013). This study evaluates adolescent, caregiver, and provider perceptions regarding the helpfulness of family-involved brief interventions, including tablet-based psychoeducation, brief counseling, and family conversation about substance use. We aim to gain a better understanding of the effectiveness and feasibility of SBIRT activities in PC.

Methods: This analysis includes helpfulness ratings from adolescents aged 12-17 (N=42), their caregivers (N=20), and primary care providers (N=15) involved in a randomized-effectiveness trial comparing two SBIRT-A (Standard [adolescent only] vs Family) approaches. Caregivers predominantly self-identified as White (46%), while adolescents primarily identified as Black (50%). Additionally, 61% of adolescents and 86% of caregivers were assigned female at birth. Participants were recruited from two hospital-affiliated pediatric primary care (PC) settings serving diverse clinical populations. Both SBIRT-A approaches utilize tablet-based interventions delivered in waiting areas (screening and psychoeducation) and provider-facing interventions delivered during appointments (brief counseling). Brief interventions for SBIRT-A-Standard includes tablet-delivered psychoeducation and adolescent brief negotiated interview delivered by the provider. SBIRT-A-Family interventions included tablet-based caregiver psychoeducation, caregiver brief negotiated interview delivered by the provider, and a provider-facilitated family conversation about substance use. Helpfulness ratings were collected digitally at baseline research interviews from adolescents and their caregivers using a 3-point Likert-type rating scale: 0 (“Not at all helpful”), 1 (“Somewhat helpful”), or 2 (“Very helpful”). Providers completed a self-report checklist using the same scale post-encounter and were invited to provide qualitative feedback for each encounter.

Results: Using simple percentages assessing the proportion of providers who rated the interventions at least “Somewhat helpful,” preliminary data suggest a strong favor for all SBIRT-A components. Tablet-based psychoeducation was rated by 97% of adolescents and 100% of caregivers as at least “Somewhat helpful” at baseline. Similarly, brief counseling was rated at least “Somewhat helpful” for 97% of adolescents and 100% of caregivers at baseline. Among providers, 72% found adolescent counseling at least “Somewhat helpful”, while only 37% rated the same for caregiver counseling, suggesting barriers to integrating caregivers into interventions. Despite these challenges, the facilitated conversation was highly rated: 45% of providers, 96% of adolescents, and 100% of caregivers found the intervention at least “Somewhat helpful”. Qualitative feedback from providers highlighted recurring challenges with caregiver-focused components, including workflow issues and time constraints. However, most providers expressed positive experiences, noting the value of tablet-delivered scripted prompts to help facilitate effective and meaningful conversations with adolescents and caregivers.

Findings suggest strong acceptability for tablet-delivered and family-inclusive SBIRT-A interventions among caregivers and adolescents, who consistently rate SBIRT components helpful even when provider ratings vary. Disparities in provider feedback reveal the need for workflow adaptations and targeted training for caregiver-focused components in SBIRT.

Conclusion & Discussion: This study highlights the potential of family-inclusive SBIRT in primary care settings through initial helpfulness ratings. Preliminary findings demonstrate high acceptability for SBIRT components, such as tablet-based psychoeducation, brief counseling, and family-based conversations, among both adolescents and caregivers. Provider feedback is generally positive, highlighting the usefulness of structured tools and noting improved communication and engagement among adolescents and caregivers. The most variability was in the caregiver counseling, with only 37% rating at least “Somewhat helpful”, despite caregivers rating the same counseling highly. This reveals the need for more targeted, caregiver-focused training for providers and workflow adaptations to more effectively integrate families into SBIRT activities. Addressing these barriers, particularly early on, can help enhance the delivery and impact of family-based SBIRT practices. Future analyses will examine the long-term impact of caregiver impact on adolescent AOD use, co-occurring behavior problems, and family communication. We will continue to test the effectiveness, feasibility, and receptivity of SBIRT-A approaches and their components in pediatric PC to reduce adolescent AOD use.

References: Hogue, A., Dauber, S., Henderson, C. E., & Liddle, H. A. (2013). Reliability of therapist self-report on treatment targets and focus in family-based intervention. Administration and Policy in Mental Health and Mental Health Services Research, 40(2), 118–130. https://doi.org/10.1007/s10488-011-0377-1

Levy, S. J., Williams, J. F., & COMMITTEE ON SUBSTANCE USE AND PREVENTION (2016). Substance Use Screening, Brief Intervention, and Referral to Treatment. Pediatrics, 138(1), e20161211. https://doi.org/10.1542/peds.2016-1211

Steinfeld, M. R., & Torregrossa, M. M. (2023). Consequences of adolescent drug use. Translational psychiatry, 13(1), 313. https://doi.org/10.1038/s41398-023-02590-4