Trial of Automated Risk Appraisal for Adolescents

The pandemic of problem drug use and abuse and related health problems among young persons
aged 12-25 in the U.S. continues unabated, in part, because opportunities for early
identification and monitoring are missed. In particular, improved recognition of, and
ongoing contact for, problem drug use and abuse among pre-teens and early adolescents in
primary care settings could provide important information to health care professionals and
engage early intervention services. Unfortunately, many barriers exist to routine screening
and monitoring in primary care settings. These include the expense of traditional paper and
pencil screening, competing demands on primary care clinicians and office staff, complex
scoring programs and the ability to track youth over time.

Innovative information technology and support services can overcome many of these barriers.
New primary care information systems allow for direct data entry by youth in healthcare
settings, automated scoring and printing, decreased staff time, individual or practice level
results and patient follow-up for intervention services. However, these assessment tools
and systems have not been adequately assessed for their roles in detecting problem drug use
and abuse in youth, and appropriate follow-up and tracking systems for those identified have
not been implemented.

Our goal is to improve services for problem drug use and abuse and other related health
risking behaviors for youth in primary care settings through early identification and
monitoring. We expand an innovative partnership among the Columbus Children’s Hospital, the
Close To Home Primary Care Centers and Flipsidemedia.com to test the efficacy and
acceptability of an early identification and monitoring system for problem drug use and
abuse, depression and related mental disorders among pre-teens and teenagers in a randomized
trial. We propose to compare care in nine Close To Home Centers with Automated Risk
Appraisal for Adolescents/Telephone Support (RA/TS) compared to usual care plus mailed
screening results (UC+). Each site will be randomly assigned to start with six months on
RA/TS or six months on UC+ and follow with the alternative in a crossover design. RA/TS is a
web-based screening and assessment tool completed by adolescents during primary care visits
and a linked, structured telephone tracking intervention consisting of three follow-up
telephone calls to youth and their families monitoring identified problems and barriers to
services. Specifically, we aim to:

1. compare frequency of problem drug use and abuse identification in RA/TS youth vs. youth
in usual care (UC+);

2. examine frequency of counseling, referral, psychotropic medication or other
interventions for youth screening positive for problem drug use and abuse on RA (Risk
Appraisal) in RA/TS youth vs. UC+ youth; and

3. evaluate the effects of the TS (Telephone Support) program on return to primary care,
likelihood of completing referrals, number of primary care visits, number of specialty
visits, and satisfaction with services after four months for youth screening positive
for problem drug use and abuse.

Inclusion Criteria:

- 11-20 years of age

- non-emergent visit in primary care office

- consent and assent (if applicable)

Exclusion Criteria:

- non-english speaking