Reducing care needs of teens with substance-abuse disorders

April 24, 2019

Kaiser Permanente researchers find long-term benefits for patients and health organizations that employ screenings, interventions, and referrals.

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 journal Pediatrics, suggests that the benefits can last for many years and can include sustained reductions in mental health conditions.

In a new study titled "Health Care Utilization Over 3 Years After Adolescent SBIRT," researchers led by Stacy Sterling, DrPH, MSW, of Kaiser Permanente's Division of Research in Northern California, found that adolescents with access to SBIRT -- short for "screening, brief intervention, and referral to treatment" -- were less likely to have mental health or chronic medical conditions after 1 year.

Substance abuse is "closely associated with the top three 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 data from electronic health records 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 in Northern California, 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."
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The National Institute on Alcohol Abuse and Alcoholism funded the study.

Sterling's co-authors include 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.

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 400 epidemiological and health services research projects. For more information, visit http://www.dor.kaiser.org or follow us @KPDOR.

About Kaiser Permanente

Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America's leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 12 million members in 8 states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to share.kaiserpermanente.org.

Kaiser Permanente

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