Department of Pediatrics, Feinberg School of Medicine, The Potocsnak Family Division of Adolescent and Young Adult Medicine, Northwestern University, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA.
Institute for Juvenile Research, Department of Psychiatry, College of Medicine, Institute for Juvenile Research, University of Illinois at Chicago, Chicago, IL, USA.
Addict Sci Clin Pract. 2024 Sep 11;19(1):67. doi: 10.1186/s13722-024-00492-4.
Adolescents with chronic medical conditions (CMC) use alcohol and marijuana at levels equal to or even greater than their peers without CMC and are more likely to initiate substance use at 14 years or younger. Approximately 33% of adolescents with CMC binge drink alcohol and 20% use marijuana. When using substances, adolescents with CMC are at elevated risk for problem use and adverse consequences given their medical conditions. Although there has recently been progress integrating substance use services into adult hospitals, there has been almost no implementation of standardized substance use services into pediatric hospitals for adolescents with CMC. Screening, Brief Intervention, and Referral to Treatment (SBIRT) for adolescents is an evidence-based, public health approach to promote the early detection and intervention of risky alcohol use in high-risk youth. This paper describes a study protocol combining two leading implementation science frameworks, the Consolidated Framework for Implementation Research (CFIR) and the Health Equity Implementation framework (HEIF), to engage pediatric hospital partners (hospital staff and clinicians, patients with CMC, and caregivers) to identify and specify contextual determinants of SBIRT implementation, which can be used to derive implementation strategies to optimize SBIRT adoption, reach, and fidelity.
This study will use semi-structured interviews and focus groups with pediatric hospital partners (e.g., hospital staff and clinicians, adolescent patients, and caregivers) to identify SBIRT implementation determinants, using semi-structured interview and focus group guides that integrate CFIR and HEIF dimensions.
Understanding implementation determinants is one of the first steps in the implementation science process. The use of two determinant frameworks highlighting a comprehensive set of determinants including health equity and justice will enable identification of barriers and facilitators that will then map on to strategies that address these factors. This study will serve as an essential precursor to further work evaluating the feasibility of and the degree of engagement with SBIRT among this vulnerable pediatric population.
患有慢性疾病的青少年（CMC）的饮酒和大麻使用率与无 CMC 的同龄人相当，甚至更高，并且更有可能在 14 岁或更年轻时开始使用物质。大约 33%的 CMC 青少年酗酒，20%的青少年使用大麻。当使用物质时，由于他们的医疗状况，CMC 青少年面临着更高的问题使用和不良后果的风险。尽管最近在将物质使用服务整合到成人医院方面取得了进展，但几乎没有将标准化的物质使用服务纳入儿科医院，以服务患有 CMC 的青少年。针对青少年的筛查、简短干预和转介治疗（SBIRT）是一种基于证据的公共卫生方法，旨在促进高危青年中危险饮酒的早期发现和干预。本文描述了一项研究方案，该方案结合了两个领先的实施科学框架，即实施研究综合框架（CFIR）和健康公平实施框架（HEIF），以吸引儿科医院合作伙伴（医院工作人员和临床医生、CMC 青少年患者和照顾者），以确定和具体说明 SBIRT 实施的情境决定因素，这些因素可用于制定实施策略，以优化 SBIRT 的采用、覆盖面和保真度。
本研究将使用半结构化访谈和焦点小组与儿科医院合作伙伴（例如，医院工作人员和临床医生、青少年患者和照顾者）进行，以使用整合了 CFIR 和 HEIF 维度的 SBIRT 实施决定因素半结构化访谈和焦点小组指南来确定 SBIRT 实施决定因素。
了解实施决定因素是实施科学过程的第一步。使用两个决定因素框架突出了包括健康公平和正义在内的一整套决定因素，将能够确定障碍和促进因素，然后将这些因素映射到解决这些因素的策略上。这项研究将作为进一步评估 SBIRT 在这一脆弱儿科人群中可行性和参与度的重要前提。
