Kaiser Permanente researchers lead international effort using promising population health approach
When teenagers are experimenting with alcohol or drugs, it is essential that they seek counseling before their drug use goes too far, especially if they are experiencing sadness or anxiety. Healthcare teams can help using methods backed by research from Kaiser Permanente.
This technique is called SBIRT (Screening, Brief Intervention, and Referral to Treatment). The idea is to screen young people in pediatric or primary care clinics to identify problematic substance use. The medical team follows up with a conversation (a brief intervention part) and refers the patient to treatment if necessary.
A team at Kaiser Permanente Research Division studying SBIRT found that participating in a pilot SBIRT program benefits pediatric patients who are at lower risk of developing mental health problems later in life.
The team is currently leading a global effort to expand the use of this technology for young patients aged 10 to 24. They hope to ensure consistent use of SBIRT across countries (the details of the short-term intervention may vary) and identify research gaps. This effort is led by the Youth Special Interest Group of INEBRIA (International Network on Brief Interventions for Alcohol and Other Drugs).
The group just published a “roadmap” document in the Journal of Adolescent Health that identifies ways to use SBIRT more widely and consistently around the world. Two of the lead authors of paper are DOR Research Scientist Stacy Sterling, PhD, MSW, and Staff Scientist Verena Metz, PhD. They answered questions about the roadmap and the potential of SBIRT.
Why is it important to apply this technique to younger patients?
Sterling: Alcohol and drug use are associated with the top three causes of mortality and morbidity among adolescents: suicide, homicide, and accidents and injuries. Young people may be motivated by their own life circumstances as well as larger societal factors such as the COVID-19 pandemic. Approaching people in adolescence, before experimentation with drug use becomes established, can make a big difference in reducing the risk of harm and negative outcomes.
Mets: There is a great chance that early intervention can completely change a patient’s course. It is extremely rewarding to work with an age group that I can help in such a practical way.
How can SBIRT be used with young people?
Sterling: There is more evidence and is more established for SBIRT in the adult population. For example, at Kaiser Permanente Northern California, SBIRT is routinely used in adult primary care.
But now there’s a lot of evidence that it’s effective for young people too. They use alcohol differently than adults. Rather than coming home from work and having a glass or two of wine, young people are more likely to drink alcohol opportunistically. They may encounter it at parties and are more likely to binge drink. And excessive drinking is becoming increasingly common among young people. Therefore, there are unique challenges when using SBIRT with young people in terms of what is developmentally appropriate and how to measure successful outcomes such as educational attainment.
In the United States, SBIRT is primarily used in medical settings. However, in other countries, this technology may be used in other settings such as schools and community centres. It is important to be aware of all the ways a technique may be used to ensure consistency in methods and training. When we say SBIRT, we are all talking about the same thing.
What did you want to achieve with this research roadmap?
Sterling: This was truly a call to move the field forward, identify research gaps, and work towards consistency.
What are the main suggestions?
Mets: The roadmap identifies several areas where research can focus and fill gaps. Thus, for example, much of the evidence regarding the use of SBIRT with adolescents is in US and European populations, with gaps by race and ethnicity. Also, the evidence base does not differentiate how this technology works by age or gender.
It would be useful to compare how the effectiveness of SBIRT differs where it is implemented, for example in health care settings and communities, and in low-income and middle-income countries. We also need a better understanding of the effects of heterogeneity across groups, for example between different racial and ethnic groups and sexual minority youth, and between girls and boys. there is. Finally, we also identify the need to specify the best outcome measures appropriate for adolescents.
How would you like this document to be used?
Sterling: It is important to reach a consensus on the screening method being used. This paper contains a list of the most commonly used screening tools around the world, but they vary. We need to provide consistent, validated screening questionnaires to clinicians and others who work with young people. This is to ensure that SBIRT is being used in the most reliable manner supported by research results and to allow researchers to collect consistent data across study sites.
Mets: Our project had some logistical challenges working collaboratively with colleagues across six time zones. However, the fact that our co-authors are experts from all over the world ensured that our publication was truly international. The authors are among the best in the SBIRT field worldwide and represent a variety of cultural backgrounds, working and learning conditions, experiences, and challenges. We hope our colleagues around the world find our roadmap useful.
Additional co-authors include Andrea H. Kline-Simon, MS, and Agatha Hinman, BA, DOR. Sharon Levy, MD, MPH, Theon Kim Harris, CPH, Elissa R. Weitzman, PhD, of Harvard Medical School; Dr. Marcus Bendtsen of Linköping University, Sweden. Sidharth Arya, MD, Pt BDS University of Health Sciences, India; Joel Moussafiri Francis, MA, PhD, University of the Witwatersrand, South Africa. Dr. Abhishek Ghosh of the Institute of Postgraduate Medical Education and Research, India; Dagmar M. Haller, MD, University of Geneva, Switzerland; Dr. Tracy L. McPherson of NORC, University of Chicago; Dr. Shannon Gwynne Mitchell of the Friends Institute in Baltimore; Dr. Dorothy Newbury-Birch of Teesside University, UK. Sameer Kumar Praharaj, MD, DPM, Kasturba Medical College, India; Dr. Paul Toner of the University of Dundee, UK.
