P2B368: Substance Use Prevention and Treatment Utilizing Screening to Brief Intervention (S2BI) in a Pediatric Primary Care Clinic: A Quality Improvement Project

Purpose/Objectives: Screening to Brief Intervention (S2BI) is a seven-item validated screening tool for adolescents, used to assess frequency of substance use in the past year. It aids clinicians in selecting appropriate interventions depending on the risk of developing a substance use disorder. S2BI demonstrates the principle of “Ask-Counsel-Treat” which was designed to address the urgent concern on youth tobacco use. The purpose of this study is to improve substance use screening among adolescents by integrating S2BI in the pediatric primary care clinic.

Design/Methods: A resident-driven quality improvement project was carried out utilizing the Plan-Do-Study-Act (PDSA) methodology. Preintervention survey and electronic medical record (EMR) review were done to determine providers’ knowledge, perceptions and practices. Education was given regarding substance use, screening and intervention strategies. After pilot study, PDSA cycle was initiated. S2BI tools (English and Spanish) were administered to adolescents 12-18 years old before the visit and reviewed with the provider. Ongoing feedbacks were obtained, and problems encountered were identified and addressed.

Results: EMR review revealed that 76% of providers failed to ask about substance use. Common reasons were time constraints, forgetting to ask, and clinical impression of no substance use. After training and pilot study, providers considered S2BI to be brief, useful, comprehensive and easy to perform. A total of 228 adolescents, ages 12-18, were screened using S2BI tool in the first 5 months of implementation, with 208 (91%) reporting No Use, 13 (6%) Once or Twice in the past year, 4 (2%) Monthly use and 4 (2%) Weekly use. Marijuana (6%) was the most common substance used followed by alcohol (4%) then tobacco (2%). For brief intervention, positive reinforcement was done in 186 (82%) of teenagers screened, Brief Advice in 18 (8%), Change Talks in 3 (1%) and Referral in 1 (0.4%). Barriers identified during the implementation were availability of screening tools, administration of tool before the encounter, provider recall of screening, knowledge of brief intervention strategies and documentation. Addressing these barriers increased the monthly screening rate from 16% to 64%. From all the interventions done, incorporation of S2BI tool to the EMR had the greatest impact on the improvement of substance use screening among adolescents in our primary care practice.

Conclusion/Discussion: In a busy practice, time constraints, knowledge deficits and lack of training may hinder identification of risky substance use. The "Ask-Counsel-Treat" model exemplified in S2BI provides a brief and consistent method to detect and address problematic use. In our clinic, most teenagers reported no use and received positive reinforcement: an indispensable strategy to delay initiation of substance use and prevent its health-related consequences. Even though other interventions were performed at a lesser extent, providers were supplied with patient-centered skills and resources to deal with substance use.