Barriers to and Facilitators of Implementation of Screening, Brief Intervention and Referral to Treatment for Risky Substance Use for Adolescents in Pediatric Primary Care: A Qualitative Interview Study

Abstract

Alcohol and other drug problems can be devastating to adolescents’ health, mental health and well-being, and early detection and intervention are critically important.1-3 Pediatric primary care, with its emphasis on health promotion is an opportune setting in which prevention and early intervention for substance use problems can occur.4,5 Screening, brief intervention and referral to treatment (SBIRT) for alcohol and drug use problems is a public health approach to early intervention for substance use problems endorsed by the National Institutes of Health, and the Department of Health and Human Services and the Substance Abuse and Mental Health Services Administration,6-9 and recommended by major medical organizations.10-15 SBIRT for adolescents has not been widely implemented in pediatric health care settings however, and there is little research on factors contributing to its implementation in pediatric primary care.16,17 This dissertation uses qualitative data from Key Informant interviews with Kaiser Permanente Northern California (KPNC) and community-based pediatric and specialty mental health and substance abuse treatment clinicians, policymakers and clinical staff to examine feasibility and factors – environmental, organizational, provider- and patient-level, and the nature of the intervention itself – which may inhibit or facilitate implementation of SBIRT in pediatric primary care. The dissertation culminates in a Plan for Change focused on pragmatic steps to facilitate the implementation of adolescent SBIRT in a large integrated healthcare delivery system, KPNC. The qualitative analysis and resulting implementation plan are informed by the findings on implementation outcomes from a cluster-randomized, hybrid implementation and effectiveness trial of different modalities of delivering SBIRT in pediatric primary care, conducted in KPNC.Doctor of Public Healt