Implementing Adolescent Screening, Brief Intervention, and Referral to Treatment (SBIRT) Education in a Pediatric Residency Curriculum

ABSTRACT

Background: Screening, brief intervention, and referral to treatment (SBIRT) is recommended as part of routine health care for adolescents as well as adults. In an effort to promote universal SBIRT, the Substance Abuse and Mental Health Services Administration awarded funding to residency programs to develop and implement SBIRT education and training. Our project focused on creating scientifically based, developmentally appropriate strategies and teaching materials for the adolescent age range. This paper describes curriculum development and implementation and presents evaluation data. Methods: Pediatric and child psychiatry residents were trained. The training consisted of 4 activities: (1) case-based teaching modules, (2) role-play of motivational interviewing and brief interventions, (3) mock interviews with trained adolescents, and (4) supervised “hands-on” screening and brief interventions. Main outcome measures included trainee satisfaction, and SBIRT knowledge, perceived self-efficacy, and self- and observer report of use of the SBIRT algorithm. Results: Among 150 total participants completing the SBIRT training modules, nearly all (92.3%) were satisfied/very satisfied with the training modules. Knowledge accuracy immediately post training was high, but declined significantly by the end of the first residency year, with little change across subsequent years of residency. Confidence ratings also declined over time. Use of the SBIRT algorithm during the Adolescent Medicine rotation was high according to trainee self- and faculty observer report. Conclusions: We found evidence of training satisfaction, increased confidence in talking to adolescents about substance use, and widespread use of recommended practices immediately following training. Use of a highly structured algorithm to guide practice, and simple, highly structured brief interventions was a successful training approach, as residents self-reported accurate use of the SBIRT algorithm immediately after training. Knowledge and self-confidence declined over time. It is possible that “booster” sessions and ongoing opportunities to review materials could help residents retain knowledge and skills.

Keywords:

• SBIRT training
• adolescent substance abuse
• residents
• brief intervention

ACKNOWLEDGMENTS

The authors would like to acknowledge Drs. Christina Nordt, Susan Gray, and Miriam Schizer for their contributions as faculty teaching the SBIRT curriculum; and Rosemary Ziemnik and Joy Gabrielli for their help in manuscript preparation.

FUNDING

This research was supported by SAMHSA grant 020267. SAMHSA monitored adherence to goals and timeline, approved additions to the specific aims, and funded a Technical Assistance grant with JBS International to conduct peer review of the modules. SAMHSA did not participate in data analysis or preparation of this publication.

AUTHOR CONTRIBUTIONS

Patricia Schram was involved in the project design, development of the modules, and collection of the forms, and analysis and interpretation of some of the results. She wrote, edited, and revised the manuscript. Sharon Levy was the Principal Investigator (PI) of this project, and provided oversight for all aspects of development and implementation. She was involved in development of teaching materials, training oversight, and data analysis and interpretation. She participated in writing, editing, and revising the manuscript. Patricia Schram and Sharon Levy are responsible for the integrity of the work as a whole, from inception to published article. Sion Kim Harris was involved in project design, development of measures, data analysis and interpretation, and drafting, editing, and final approval of the manuscript. Roman Pavlyuk was involved in the project implementation, collection and analysis of data, as well editing and revising the manuscript. Shari Van Hook was involved in the project design and management as well as review of results, and editing and revising the manuscript. Sara Forman was involved in design of some of the resident evaluation forms (resident observation and SBIRT forms) and helped develop the first overview module. She was also involved with teaching and implementation of the teaching protocol on the Adolescent Clinic, and in collection of data forms from residents. Dr. Forman also assisted in data interpretation and writing and revising the paper. Enrico Mezzacappa was involved in the conception, design, and adaptation of the modules for the child psychiatry residents, the collection of data (from the child psychiatry residents), and writing and revising of the manuscript. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.