Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Curr Opin Pediatr. 2024 Aug 1;36(4):358-366. doi: 10.1097/MOP.0000000000001359. Epub 2024 Apr 12.
Improving adolescent substance use prevention and treatment is an urgent public health priority in the United States. Current intervention models do not address how adolescents with a history of caregiver substance use are at particular risk for problematic substance use. We, therefore, reviewed the evidence on adolescent substance use prevention programs integrating caregiver-focused components and propose opportunities to incorporate adaptations of existing programs into pediatric primary care to improve outcomes for at-risk adolescents exposed to caregiver substance use.
There are multiple evidence-based universal prevention programs that target adolescent substance use and incorporate caregivers; however, these programs do not address the specific concerns of caregivers with substance use. Caregiver-focused programs efficaciously address family and child risk factors for adolescent substance use but are not accessible to many families and have not been longitudinally studied to assess impact on adolescent substance use.
Adaptation of existing prevention programs to pediatric primary care settings may open opportunities to improve engagement of families with caregiver substance use in targeted prevention strategies. Family Screening, Brief Intervention, and Referral to Treatment (F-SBIRT) is one model that can be incorporated into pediatric primary care to contextualize evidence-based practices to address substance use in a family-focused approach. To develop F-SBIRT, further research is needed to validate caregiver-focused screening tools, determine brief intervention (BI) best practices, and adapt existing evidence-based and caregiver-focused adolescent prevention programs for use with caregivers with substance use in pediatric primary care settings.
改善青少年物质使用预防和治疗是美国当前迫切的公共卫生重点。目前的干预模式并未解决有照顾者物质使用史的青少年特别容易出现物质使用问题的问题。因此，我们回顾了关于将以照顾者为重点的内容纳入青少年物质使用预防计划的证据，并提出了将现有计划改编为儿科初级保健以改善接触照顾者物质使用的高危青少年的结果的机会。
有多个针对青少年物质使用并纳入照顾者的循证通用预防计划；然而，这些计划并未解决有物质使用问题的照顾者的具体问题。以照顾者为重点的计划有效地解决了青少年物质使用的家庭和儿童风险因素，但许多家庭无法获得这些计划，并且尚未进行纵向研究以评估其对青少年物质使用的影响。
将现有的预防计划改编为儿科初级保健环境可能为接触有照顾者物质使用的家庭提供机会，使其参与有针对性的预防策略。家庭筛查、简短干预和转介治疗（F-SBIRT）是一种可纳入儿科初级保健的模式，可将循证实践置于以家庭为中心的方法中，以解决物质使用问题。为了开发 F-SBIRT，需要进一步研究来验证以照顾者为重点的筛查工具，确定简短干预（BI）最佳实践，并改编现有的基于证据和以照顾者为重点的青少年预防计划，以便在儿科初级保健环境中用于有物质使用问题的照顾者。
