Implementation Barriers to and Facilitators of Screening, Brief Intervention, Referral, and Treatment (SBIRT) in Federally Qualified Health Centers (FQHCs). Summary of Findings: Adolescent Sbirt in Fqhcs


Adolescent alcohol and drug use is a public health concern and a major contributor to health problems among youth, including smoking, at-risk sexual behavior, impaired driving, depression, low academic achievement, delinquency, and violence.289, 290, 291, 292, 293, 294, 295 Adolescents who drink are at higher risk for developing substance abuse disorders later in life, with risk increasing as age of initiation of alcohol use decreases.293, 296, 297, 298, 299, 300, 301, 302, 303 The prevalence of adolescent SUDs is 8 percent,304 and more than double that, 19 percent, among adolescents who have ever used alcohol or drugs.269, 289 Some research indicates that alcohol SBI is effective as an early identification and prevention approach to reducing underage drinking294, 305, 306, 307, 308 and use of substance.309, 310, 311, 312 But studies are inconsistent and effect sizes are small.313 Over the last 15 years, national and international public health agencies and medical professional associations including the U.S. Surgeon General,293 the NIAAA,314 the WHO,133 the American Medical Association,315 the HRSA Maternal Child Health Bureau, Bright Futures,316 and the American Academy of Pediatrics292, 317 have called for adolescent health care providers to routinely screen adolescents for alcohol and drug use and to provide brief preventive and early intervention counseling. However, the USPSTF has so far concluded that the current evidence is insufficient to assess the balance of benefits and harms of SBI among adolescents in primary care.

Fewer than half of pediatricians systematically screen adolescents for alcohol or other drugs,240 citing as barriers lack of time, inadequate reimbursement, lack of training, and uncertainty about referral sources.240, 318 Few adolescents who already meet the criteria of a SUD or who use substances in high-risk manners are identified early or receive treatment they could benefit from. The National Survey on Drug Use and Health304 finds that only 7 percent of adolescents who could benefit from treatment for their SUDs actually get that care.

Using the five dimensions of the CFIR model, we systematically evaluated the research on integrating alcohol and drug screening, brief intervention, and treatment into primary care practice. Few studies of adolescent substance use SBI have been conducted in FQHCs. The previous CFIR analyses of barriers to and facilitators of adult SBI likely hold for adolescents, but some specifics will be highlighted.

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