Primary Connections for Youth and Families

NCT ID: NCT05964010

Last Updated: 2024-05-06

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

2300 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-03-01

Study Completion Date

2027-11-30

Brief Summary

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The goal of this clinical trial is to compare a standard adolescent-only approach to substance use screening, brief intervention, and referral to treatment to a in primary care settings. Primary outcomes (AOD use, co-occurring behavior problems, parent-youth communication about AOD use) and secondary outcomes (adolescent quality of life, therapy attendance) are assessed at screen/initial and 3, 6, 9, and 12 months follow-up.

Detailed Description

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This randomized effectiveness trial compares a standard adolescent-only approach (SBIRT-A-Standard) versus a family-based approach (SBIRT-A-Family) in which caregivers are systematically included in screening, intervention, and referral activities. The study includes N = 2,300 adolescents (age 12 - 17) and their caregivers attending one of three hospital-affiliated pediatric settings serving diverse patients in major urban areas. Study recruitment, initial screening, randomization, and all SBIRT-A activities occur during a single pediatric visit. SBIRT-A procedures are delivered primarily in digital format on hand-held tablets using both patient-facing and provider-facing programming. Primary outcomes (AOD use, co-occurring behavior problems, parent-youth communication about AOD use) and secondary outcomes (adolescent quality of life, therapy attendance) are assessed at screen/initial and 3, 6, 9, and 12 months follow-up. The study is well powered to conduct all planned main and moderator (age, sex, race/ethnicity, youth AOD risk status) analyses.

Conditions

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Substance Use

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Standard adolescent-only approach to screening, brief intervention, and referral to treatment for adolescent substance use (SBIRT-A-Standard) versus a family-based approach (SBIRT-A-Family) in which caregivers are systematically included in screening, intervention, and referral activities.
Primary Study Purpose

SCREENING

Blinding Strategy

SINGLE

Outcome Assessors
Research staff collecting initial and follow-up assessment are blinded to study condition.

Study Groups

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SBIRT-A-Standard

Standard adolescent-only approach to screening, brief intervention, and referral to treatment for adolescent substance use.

Group Type ACTIVE_COMPARATOR

Standard Screening

Intervention Type BEHAVIORAL

All consented youth age 12-17 years complete a patient-facing, well-validated digital screening tool, the CRAFFT (Knight et al., 2003), which assesses number of days during the past year, and then the past 3 months, during which various formulations of AOD were used. If youth report 0 days of AOD use, the tool asks whether they have ridden in a car whose driver was intoxicated; if this response is negative, they are categorized Low Risk. If youth report \> 0 days of AOD use, the tool asks five additional questions assessing use risk and consequences; also, youth who report nicotine use in the past 30 days complete a nicotine dependence checklist (DiFranza et al., 2002). Screen data are then combined to sort youth into three risk categories: Riding Risk Only (no reported AOD use but indicated rode in car driven by intoxicated person), Distant Use (reported AOD use in past year but not past 3 months), or Recent Use (reported AOD use in past 3 months).

Standard Psychoeducation

Intervention Type BEHAVIORAL

In the wait area, youth receive a tablet-delivered brief digital AOD education tutorial that includes advice to abstain from or reduce AOD use. The tutorial focuses on adolescent AOD prevalence rates and related behavioral symptoms; AOD use neurobiology and its relation to adolescent health; and common AOD impacts on developmental milestones (see Meredith et al., 2021). Psychoeducation for AOD has shown positive effects as both a universal and selective prevention strategy (Bröning et al., 2021; Das et al., 2016).

Standard Brief Negotiated Interview (BNI)

Intervention Type BEHAVIORAL

In primary care (PC) office, youth and providers together complete a tablet-supported brief negotiated interview (BNI; see Beaton et al., 2016). The BNI is informed by AOD use data gathered during youth screening (O'Grady et al., 2015). The BNI focuses on (a) education about AOD disorders, including youth and family factors that impact AOD use; (b) user-tailored feedback comparing the given youth's AOD use and related problems to national norms, along with information on neurobiological effects and developmental impacts of frequent use (Harris et al., 2012); (c) motivational tools (e.g., reduction readiness rulers) and decisional balance exercises (weighing positive versus negative personal impacts of AOD use) tailored to the youth's use levels (Slavet et al., 2006; King et al., 2009); and (d) AOD reduction goal-setting interventions tailored to the youth's readiness to change AOD use (Walton et al., 2013).

Standard Referral to Treatment (RT)

Intervention Type BEHAVIORAL

In primary care (PC) offices providers and youth discuss the value of attending counseling services to address AOD-related problems (Cucciare et al., 2015); counseling referral links that the PC site curates with local services; and the value of youth talking directly with caregivers about their AOD involvement as a first step toward support-seeking and behavior change (Gayes \& Steele, 2014). Providers directly recommend AOD counseling and facilitate a first appointment for youth who agree.

SBIRT-A-Family

Family-based approach to screening, brief intervention, and referral to treatment for adolescent substance use in which caregivers are systematically included in screening, intervention, and referral activities.

Group Type EXPERIMENTAL

Family Screening

Intervention Type BEHAVIORAL

Screening procedures incorporate procedures for youth described for Standard Screening. They also incorporate two sources of caregiver-report data. First is an estimate of youth AOD use based on the Screening 2 Brief Intervention tool (Levy et al., 2016). Second is a 9-item checklist of youth mental health (MH) problems (Achenbach \& Rescorla, 2001). If both youth and caregiver report no AOD use or clinical-level MH problem, the family is categorized Low Risk. Otherwise, screen data are combined to sort families into three risk categories: Hidden SU Risk (youth reports AOD use in past year; caregiver reports no youth AOD use in past year), Named MH Risk (caregiver reports no youth AOD use in past year; caregiver reports clinical-level score for at least one youth MH domain), Named SU Risk (caregiver reports youth AOD use in past year).

Family Psychoeducation

Intervention Type BEHAVIORAL

Youth proceed as indicated in the SBIRT-A-Standard condition based on youth screen data. In the wait area, caregivers receive a tablet-delivered parenting tutorial that covers two AOD risk domains: education about adolescent AOD including prevalence rates, related behavior problems, neurobiological and health effects, and impacts on developmental milestones; and education and video modeling about parenting strategies that reduce or moderate AOD risk, including positive communication, fair and consistent discipline, and non-judgmental conversations about AOD use (Bo et al., 2018). Positive parenting education has been shown effective as a universal and selective prevention strategy in parent-focused AOD prevention trials (Kuntsche \& Kuntshce, 2016; Ladis et al., 2019; Van Ryzin et al., 2017). Tutorials are tailored for each risk category.

Family Brief Negotiated Interview (BNI)

Intervention Type BEHAVIORAL

Youth proceed as indicated in the SBIRT-A-Standard condition based on youth screen data. In primary care (PC) offices, caregivers and providers together complete a tablet-supported parenting BNI informed by data from the caregiver screen only that parallels the youth BNI (e.g., AOD education, developmental risks) and also includes motivation, modeling, and goal-setting on positive parenting (e.g., non-judgmental conversations; see above) and effective parent-youth communication about AOD use (Carver et al., 2017).

Family Facilitated Conversation (FC) & Referral to Treatment (RT)

Intervention Type BEHAVIORAL

In PC offices, providers meet separately with youth and caregivers to discuss the value of talking directly with the other family member about AOD risk while practicing positive communication strategies. Whenever both youth and caregiver agree to talk together, providers convene a brief facilitated conversation about AOD risk. In this conversation providers (a) emphasize that a positive youth-caregiver relationship is the strongest protective factor for youth development and (b) follow guidelines for brief triadic risk-reduction interventions focused on positive family communication about AOD risk (Guilamo-Ramos et al., 2020). When indicated, providers directly recommend AOD counseling and facilitate a first appointment for families who agree.

Interventions

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Standard Screening

All consented youth age 12-17 years complete a patient-facing, well-validated digital screening tool, the CRAFFT (Knight et al., 2003), which assesses number of days during the past year, and then the past 3 months, during which various formulations of AOD were used. If youth report 0 days of AOD use, the tool asks whether they have ridden in a car whose driver was intoxicated; if this response is negative, they are categorized Low Risk. If youth report \> 0 days of AOD use, the tool asks five additional questions assessing use risk and consequences; also, youth who report nicotine use in the past 30 days complete a nicotine dependence checklist (DiFranza et al., 2002). Screen data are then combined to sort youth into three risk categories: Riding Risk Only (no reported AOD use but indicated rode in car driven by intoxicated person), Distant Use (reported AOD use in past year but not past 3 months), or Recent Use (reported AOD use in past 3 months).

Intervention Type BEHAVIORAL

Standard Psychoeducation

In the wait area, youth receive a tablet-delivered brief digital AOD education tutorial that includes advice to abstain from or reduce AOD use. The tutorial focuses on adolescent AOD prevalence rates and related behavioral symptoms; AOD use neurobiology and its relation to adolescent health; and common AOD impacts on developmental milestones (see Meredith et al., 2021). Psychoeducation for AOD has shown positive effects as both a universal and selective prevention strategy (Bröning et al., 2021; Das et al., 2016).

Intervention Type BEHAVIORAL

Standard Brief Negotiated Interview (BNI)

In primary care (PC) office, youth and providers together complete a tablet-supported brief negotiated interview (BNI; see Beaton et al., 2016). The BNI is informed by AOD use data gathered during youth screening (O'Grady et al., 2015). The BNI focuses on (a) education about AOD disorders, including youth and family factors that impact AOD use; (b) user-tailored feedback comparing the given youth's AOD use and related problems to national norms, along with information on neurobiological effects and developmental impacts of frequent use (Harris et al., 2012); (c) motivational tools (e.g., reduction readiness rulers) and decisional balance exercises (weighing positive versus negative personal impacts of AOD use) tailored to the youth's use levels (Slavet et al., 2006; King et al., 2009); and (d) AOD reduction goal-setting interventions tailored to the youth's readiness to change AOD use (Walton et al., 2013).

Intervention Type BEHAVIORAL

Standard Referral to Treatment (RT)

In primary care (PC) offices providers and youth discuss the value of attending counseling services to address AOD-related problems (Cucciare et al., 2015); counseling referral links that the PC site curates with local services; and the value of youth talking directly with caregivers about their AOD involvement as a first step toward support-seeking and behavior change (Gayes \& Steele, 2014). Providers directly recommend AOD counseling and facilitate a first appointment for youth who agree.

Intervention Type BEHAVIORAL

Family Screening

Screening procedures incorporate procedures for youth described for Standard Screening. They also incorporate two sources of caregiver-report data. First is an estimate of youth AOD use based on the Screening 2 Brief Intervention tool (Levy et al., 2016). Second is a 9-item checklist of youth mental health (MH) problems (Achenbach \& Rescorla, 2001). If both youth and caregiver report no AOD use or clinical-level MH problem, the family is categorized Low Risk. Otherwise, screen data are combined to sort families into three risk categories: Hidden SU Risk (youth reports AOD use in past year; caregiver reports no youth AOD use in past year), Named MH Risk (caregiver reports no youth AOD use in past year; caregiver reports clinical-level score for at least one youth MH domain), Named SU Risk (caregiver reports youth AOD use in past year).

Intervention Type BEHAVIORAL

Family Psychoeducation

Youth proceed as indicated in the SBIRT-A-Standard condition based on youth screen data. In the wait area, caregivers receive a tablet-delivered parenting tutorial that covers two AOD risk domains: education about adolescent AOD including prevalence rates, related behavior problems, neurobiological and health effects, and impacts on developmental milestones; and education and video modeling about parenting strategies that reduce or moderate AOD risk, including positive communication, fair and consistent discipline, and non-judgmental conversations about AOD use (Bo et al., 2018). Positive parenting education has been shown effective as a universal and selective prevention strategy in parent-focused AOD prevention trials (Kuntsche \& Kuntshce, 2016; Ladis et al., 2019; Van Ryzin et al., 2017). Tutorials are tailored for each risk category.

Intervention Type BEHAVIORAL

Family Brief Negotiated Interview (BNI)

Youth proceed as indicated in the SBIRT-A-Standard condition based on youth screen data. In primary care (PC) offices, caregivers and providers together complete a tablet-supported parenting BNI informed by data from the caregiver screen only that parallels the youth BNI (e.g., AOD education, developmental risks) and also includes motivation, modeling, and goal-setting on positive parenting (e.g., non-judgmental conversations; see above) and effective parent-youth communication about AOD use (Carver et al., 2017).

Intervention Type BEHAVIORAL

Family Facilitated Conversation (FC) & Referral to Treatment (RT)

In PC offices, providers meet separately with youth and caregivers to discuss the value of talking directly with the other family member about AOD risk while practicing positive communication strategies. Whenever both youth and caregiver agree to talk together, providers convene a brief facilitated conversation about AOD risk. In this conversation providers (a) emphasize that a positive youth-caregiver relationship is the strongest protective factor for youth development and (b) follow guidelines for brief triadic risk-reduction interventions focused on positive family communication about AOD risk (Guilamo-Ramos et al., 2020). When indicated, providers directly recommend AOD counseling and facilitate a first appointment for families who agree.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Youth aged 12-17 years with a primary caregiver (i.e., parental figure) also in attendance to primary care appointment
* Youth and caregiver are fluent in English or Spanish
* Youth and caregiver are capable of using audio-assisted informed consent procedures and independently operating a hand-held tablet device
* Youth and caregiver are complete routine site AOD risk screening questions prompted during PC visit intake
Minimum Eligible Age

12 Years

Maximum Eligible Age

17 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Abt Associates

INDUSTRY

Sponsor Role collaborator

Northwestern University Feinberg School of Medicine

OTHER

Sponsor Role collaborator

UConn Health

OTHER

Sponsor Role collaborator

Massachusetts General Hospital

OTHER

Sponsor Role collaborator

Boston Medical Center

OTHER

Sponsor Role collaborator

Boston Children's Hospital

OTHER

Sponsor Role collaborator

Columbia University

OTHER

Sponsor Role collaborator

Patient-Centered Outcomes Research Institute

OTHER

Sponsor Role collaborator

The National Center on Addiction and Substance Abuse at Columbia University

OTHER

Sponsor Role lead

Responsible Party

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Aaron Hogue

Director, Family and Adolescent Clinical Technology & Science (FACTS)

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Aaron Hogue, PhD

Role: PRINCIPAL_INVESTIGATOR

Partnership to End Addiction

Locations

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Columbia University Medical Center

New York, New York, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Nicole P Porter, PhD

Role: CONTACT

212-841-5265

Facility Contacts

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Hetty Cunningham, MD

Role: primary

References

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Hogue A, Porter NP, Ozechowski TJ, Becker SJ, O'Grady MA, Bobek M, Cerniglia M, Ambrose K, MacLean A, Hadland SE, Cunningham H, Bagley SM, Sherritt L, O'Connell M, Shrier LA, Harris SK. Standard Versus Family-Based Screening, Brief Intervention, and Referral to Treatment for Adolescent Substance Use in Primary Care: Protocol for a Multisite Randomized Effectiveness Trial. JMIR Res Protoc. 2024 May 31;13:e54486. doi: 10.2196/54486.

Reference Type DERIVED
PMID: 38819923 (View on PubMed)

Other Identifiers

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AU-2022C1-26455

Identifier Type: -

Identifier Source: org_study_id

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