Substance use usually (90%) begins during adolescence, causing brain and liver damage, risky sexual and driving behavior, and potentially leading to addiction therefore prevention and early intervention programs targeting teens are needed to prevent this morbidity, gain productive years of life and reduce costs. This proposal presents innovations to overcome the barriers to effectively addressing teen substance use during primary care visits through further development of a promising computerized alcohol and substance use computerized Screening and provider Brief Advice system (cSBA) and integration with an online “clinical process support system” called CHADIS. CHADIS addresses all pediatric screening needs and is currently widely used in pediatric practice making widespread dissemination of a CHADIS-cSBA module immediately feasible. However, because of limitations related to time and training the approach of motivational interviewing (MI), with strong evidence for effecting behavior change in substance users, was not a part of cSBA. An innovation proposed here will take pre-visit teen data related to strengths and goals and acknowledged reasons for usage to populate individualized “teleprompters” accessible at the moment of care by PCP’s along with options for sharing graphical representations for use in reinforcing abstinence or motivate discontinuing usage. In addition, the prompts for discussion of teen identified strengths and goals will include wording from teen studies using “incremental theory”(or the belief that people have the potential to change), which has shown result in improvements in social coping. CHADIS-cSBA will also provide each teen a confidential individualized portal automatically populated with supports for their endorsed strengths and other supports as well as substance-related follow-up messaging. Post-visit parent education will include access to a Teen Safe course. Teens found to have serious substance abuse or dual diagnoses will have referrals facilitated by care coordination functionality. PCP participation will be reinforced by a American Board of Pediatrics accredited quality improvement program for their required re-certification (MOC-4). In Phase 1, the CHADIS-cSBA module will be created with both professional and teen feedback and MOC-4 certification obtained. In Phase 2 the resulting system will be piloted; a baseline of substance use screening conducted; then CHADIS-cSBA module will be randomly assigned to doctors and a quality improvement intervention will be conducted to measure reduction in rates of any substance use at 3 and 12 month follow-up compared to treatment as usual.

This proposal will create innovations to overcome the barriers to effectively addressing teen substance use (SU) in primary care visits through further development of a promising computerized alcohol and substance use computerized Screening and provider Brief Advice system (cSBA) and integration with an online “clinical process support system” (CHADIS). The planned enhancements in the new CHADIS-cSBA module will address barriers of time and doctor training through: collection of comprehensive pre-visit data in an online questionnaire that has interactive education about SU; individualized “teleprompters” for the doctor to use for supporting teen strengths and conducting a motivational interview (MI) to quit or reduce use pre-populated by questionnaire results; post-visit education and resources automatically provided in a confidential individual portal; parent video education about SU; and a parent-teen Contract for Life. The CHADIS-cSBA system will be developed with teen and professional interview input and then tested for effectiveness through a randomized control quality improvement trial supplemented by Board recertification credits for doctors with the outcome to be measured of reduced rates of substance use at 3 and 12 month follow-up compared to treatment as usual.