Family-Focused Interventions to Prevent Substance Use Disorders in Adolescence Proceedings of a Workshop (2022) / Chapter Skim
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3 Barriers to and Opportunities for Program Implementation and Widespread Scale-Up
3 Barriers to and Opportunities for Program Implementation and Widespread Scale-Up
Pages 23-36
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Translating In-Person Interventions to Virtual Platforms Yannine Estrada, research assistant professor at the University of iami School of Nursing and Health Studies, reviewed the implementaM tion of eHealth Familias Unidas in pediatric primary care settings. This program is an online adaptation of the Familias Unidas intervention, which is a culturally informed program focused on preventing drug use and sexual risk behaviors among Latinx youth.
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Third, the research team paired the video sessions with interactive exercises asking parents key questions. Estrada explained that the last component uses video-conferencing software to deliver virtual family sessions, which are the same as the family sessions conducted as part of the in-person intervention.
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However, Shaw noted, primary care settings also have several benefits, including trust and familiarity from families, sustainable infrastructure, and broad access. As one example of embedding evidence-based interventions into an existing primary care setting, Shaw explained a screening and intervention program, the former using the Ridenour Youth Risk Index, which includes 23 items that were the best predictors of substance use one year later in a longitudinal study.
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demonstrated how intervening for children as young as two can lead to decreased substance use in adolescence by reducing lifetime risk factors and increasing lifetime protective factors. Shaw also commented on genetic risk factors related to substance abuse.
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She highlighted four components to consider in these discussions: the culture of prevention; differing infrastructures for delivering best practices; internal organizational barriers and facilitators; as well as laws and policies at the local, state, and federal levels. Culture of Prevention The culture of prevention is the values, beliefs, and knowledge about prevention and its role within health promotion, Miller explained.
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Differing Infrastructures Miller called attention to the infrastructure needed to support the implementation of prevention strategies. Schools and health care settings provide great opportunities because of their easy access to the targeted age group, she said.
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To better prepare for implementation, Miller noted, organizations should work with implementation science experts, invest in training in both the program and family engagement techniques, and engage in collaborative work and knowledge sharing with other community organizations and resources. Laws and Policies Lastly, Miller reviewed the barriers to and facilitators for laws and policies that support prevention interventions.
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Parent-Focused Prevention in Integrated Care Systems Jordan Braciszewski, associate research scientist and clinical psychologist at Henry Ford Health, presented his work on introducing a parentfocused prevention program into three integrated health care systems across the country, including Kaiser Permanente Northern California, Kaiser Permanente Colorado, and Henry Ford Health. He said Henry Ford Health, one of the largest integrated health systems in Michigan, is unique because they have embedded health researchers in most areas of care, enabling teams to be nimbler during implementation and delivery of programs since they are already working together.
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Braciszewski shared results from randomized controlled trials that demonstrate GGC as an effective program in reducing use of alcohol, cannabis, and cigarettes, as well as reducing depressive symptoms and antisocial behaviors over time. The two Kaiser systems and Henry Ford Health are conducting a cluster randomized trial of GGC, said Braciszewski.
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He reiterated earlier comments on issues of uneven supply and demand within the workforce, noting that most systems, especially those that are under-resourced, have very few behavioral health staff. Competing priorities can also make it difficult for patients seeking preventive services to access the staff they need, he added, especially when the staff are in short supply, because of the need to address more emergent mental health concerns (e.g., serious mental illness, suicidality)
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. Current alternative payment models may not provide adequate incentives for the transformation necessary to address those determinants of health care cost that lie outside current clinic workflows, he noted.
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Matson also suggested developing competencies in universal prevention programs, specifically increasing adoption of the evidence-based Screening, Brief Intervention, and Referral to Treatment. Echoing previous speakers, Matson noted that time constraints are a critical issue for many providers.
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Level II: Moderately demanding or resource-intensive activities • Designate an office champion to implement comprehensive screening; • Familiarize providers with talking tools and messaging (e.g., marijuana tool kit) ; • Screen for liability of substance misuse or abuse before it occurs; and • Provide an online parenting program and support parent engagement.
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From page 36... ...
Smith acknowledged this challenge, saying there is some pushback because some family-focused interventions have not been tested in the pediatric primary care system, even though they have been successful in homes, schools, and online. He suggested the cumulative trial proposed by Hendricks Brown as a potential novel research design, in which as soon as there is evidence beyond reasonable doubt, you shift into replication within the same grant period.
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