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ER health promotion advocates help teens struggling with substance use get treatment

April 26, 2017

BOSTON -- Health promotion advocates in the pediatric emergency room serve as a vital resource for young people experimenting with substances and linking them with necessary resources and treatment, according to a new study out of Boston Medical Center (BMC) and Boston University School of Public Health (BUSPH).

The American Academy of Pediatrics recommends that all adolescents be screened for substance use, emotional well-being, risk reduction and violence and injury prevention as part of their routine checkups with a pediatrician. However, adolescents have some of the lowest visitation rates to a primary care doctor for regular check-ups compared to all age groups in the US. As a result, many teens rely on emergency rooms for both urgent and non-urgent medical care.

"We know that adolescence is a critical period for brain development and substance use experimentation puts teens at risk for injury and poor school performance," said Edward Bernstein, MD, emergency medicine physician and director of Project Assert at BMC who served as the study's senior author. "The pediatric emergency room presents a unique opportunity to discuss and promote prevention and link teens to treatment."

Health promotion advocates are trained in identifying health and safety needs, enhancing motivation for change and providing a menu of options and resources. Over four years, health promotion advocates screened 2,149 pediatric emergency room patients at BMC, aged 14 to 21 years old, for risky behaviors such as binge drinking, violence, unprotected sex, and drug use. Thirty-seven percent screened positive for drug or alcohol use, and of that group, 81 percent participated in an intervention that encouraged change.

Once teens screened positive, the advocates had conversations with them about the risks associated with substance use and referred them to a primary care physician or an array of substance use disorder treatment services, including outpatient counseling, community support programs and detox units.

"Our goal was to provide comprehensive, preventive services to at-risk teens in a way that could be integrated into the existing model of care," said Judith Bernstein, RNC, PhD, professor of community health sciences and emergency medicine at BUSPH and Boston University School of Medicine (BUSM) who served as the study's corresponding author. "It was essential that the advocates look beyond the substance use and address the underlying behaviors of these teens in order to effectively and successfully promote a positive change."

Researchers say the advocates were essential to helping pediatric emergency room patients navigate preventive support services for substance use and working beyond the current scope of pediatric ER teams, however, future research is needed to determine the long-term effects of the intervention.
The study is published in the Journal of Pediatric Emergency Care and was supported in part by a grant (#RFR703015) from the Massachusetts Department of Public Health, Bureau of Substance Abuse Services. Study collaborators include David Dorfman, MD, chief of the division of pediatric emergency medicine at BMC and associate professor of pediatrics at BUSM; Deric Topp, MPH, assistant director of the BNI-ART Institute at BUSPH; Hosana Mamata, MPH, and Sara Jaffer, MPH, from the department of Community Health Sciences at BUSPH; and Julie Lunstead, MPH, project manager for the Adolescent Substance Abuse Program at Boston Children's Hospital.

About Boston Medical Center

Boston Medical Center is a private, not-for-profit, 487-bed, academic medical center that is the primary teaching affiliate of Boston University School of Medicine. It is the largest and busiest provider of trauma and emergency services in New England. It offers specialized care for complex health problems and is a leading research institution, receiving more than $117 million in sponsored research funding in fiscal year 2016. It is the 13th largest recipient of funding in the U.S. from the National Institutes of Health among independent hospitals. In 1997, BMC founded Boston Medical Center Health Plan, Inc., now one of the top ranked Medicaid MCOs in the country, as a non-profit managed care organization. Boston Medical Center and Boston University School of Medicine are partners in the Boston HealthNet - 14 community health centers focused on providing exceptional health care to residents of Boston. For more information, please visit

About Boston University School of Public Health

Boston University School of Public Health, founded in 1976, offers master's- and doctoral-level education in public health. The faculty in six departments (biostatistics; community health sciences; environmental health; epidemiology; global health; and health law, policy & management) conducts policy-changing public health research around the world, with the mission of improving the health of populations -- especially the disadvantaged, underserved, and vulnerable -- locally, nationally, and internationally.

Boston University Medical Center

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