Substance use screening, brief intervention, and referral to treatment training for emergency medicine trainees.

INTRODUCTION: Emergency medicine (EM) providers are in an opportunistic position to identify and intervene with patients at risk for alcohol misuse and related problems. However, alcohol screening, brief intervention, and referral to treatment (SBIRT) services are underutilized within the emergency department. Providing SBIRT training to trainees may help to increase utilization of these valuable services in the future. An SBIRT training program for EM faculty and trainees was developed and delivered to increase trainees' skills and practice of SBIRT services. METHODS: The SBIRT training program included unique tracks for medical students, physician assistant (PA) students, EM residents and faculty preceptors. Faculty and trainees completed performance measures at the end of each training session, 30 days post-training and 12 months later. RESULTS: SBIRT training was provided to 238 trainees and 65 faculty members. At all follow-up time points, satisfaction of training and usefulness varied by trainee type with PA students rating constructs higher than both medical students and EM residents. At the 12-month follow-up survey, there was no significant difference in ratings of sharing the information (χ2 (2)=0.38, P=0.33) between these trainees, with the majority of all trainees (96% of PA students, 83% of residents and 68% of medical students) responding that they had applied what they learned in the training to their work. CONCLUSION: An SBIRT training curriculum for EM trainees was delivered successfully and utilized 12 months after implementation.

Feasibility and Acceptability of an Electronic Parenting Skills Intervention for Parents of Alcohol-Using Adolescent Trauma Patients.

Background: Identifying problem drinkers and providing brief intervention (BI) for those who screen positive are required within all level I trauma centers. While parent-adolescent relationships impact adolescent alcohol use, parenting skills are rarely included in adolescent alcohol BIs within pediatric trauma centers. Introduction: The primary objective of this study was to examine the feasibility and acceptability of an electronic parenting skills intervention for parents of injured adolescents who report alcohol or drug use. Materials and Methods: Across three pediatric level I trauma centers, admitted trauma patients 12-17 years of age, screening positive for alcohol or drug use, were consented along with one parent. Adolescent-parent dyads were enrolled and assigned to the intervention (Parenting Wisely web-based modules coupled with text messaging) or standard care conditions using a 2:1 allocation ratio. Teens completed 3- and 6-month follow-up surveys; parents completed 3-month follow-up surveys. Results: Thirty-seven dyads were enrolled into the study. Only one-third of parents accessed the web-based Parenting Wisely after baseline. All parents completed the text message program. At 3-month follow-up, 78% of parents endorsed that they would recommend the program to others. There were no significant differences in adolescent substance use or parenting behaviors between groups at follow-up. Discussion: A texting component is well received, but web-based components may be underutilized. Larger studies are necessary to determine if an electronic skills intervention has an effect on parenting skills and adolescent substance use. Conclusions: This study demonstrated accessibility and feasibility of an e-parenting intervention with more utilization of text components than web-based.

Alcohol and Other Drug Use in a Sample of Admitted Adolescent Trauma Patients.

INTRODUCTION: Alcohol screening, brief intervention and referral to treatment is mandated within the level 1 pediatric trauma center. However, data on the prevalence of alcohol and drug use among admitted pediatric trauma patients is limited. Our study objective was to describe substance use and related negative consequences in admitted adolescent trauma patients across three pediatric level 1 trauma centers. METHODS: This surveillance study was nested within a study on electronically delivered parenting skills education to parents of admitted adolescents (12-17 years) screening positive for alcohol or drug use. Enrolled adolescents completed baseline assessments to examine demographics, substance use and related negative consequences. Thirty-seven parent-adolescent dyads enrolled in the intervention study. RESULTS: Participants were eligible if they received a positive CRAFFT score or a positive biological screen for alcohol or drug use at time of the hospital admission. Of those enrolled into the study, 9 (24%) reported no substance use in the prior 12 months in our assessment battery. Of the remaining 28 patients, 6 (16%) reported using only alcohol, 10 (27%) only marijuana, 9 (24%) both alcohol and marijuana, and 3 (8%) alcohol and marijuana with other drugs in the past 12 months. Negative consequences reported varied between those who reported alcohol use only and those who reported marijuana use only with physical consequences of use most often being reported by those using alcohol (hangover, vomiting), and psychosocial consequences (getting into trouble with parents, doing something later regret) by those who used only marijuana. CONCLUSION: These findings support the use of laboratory screening and screening questionnaires for all adolescent trauma admissions to capture a complete picture of alcohol and drug use.