Implementing Alcohol Misuse SBIRT in a National Cohort of Pediatric Trauma Centers-a type III hybrid effectiveness-implementation trial

Michael J Mello, Sara J Becker, Julie Bromberg, Janette Baird, Mark R Zonfrillo, Anthony Spirito, Michael J Mello, Sara J Becker, Julie Bromberg, Janette Baird, Mark R Zonfrillo, Anthony Spirito

Abstract

Background: The American College of Surgeons mandates universal screening for alcohol misuse and delivery of an intervention for those screening positive as a requirement for certification as a level 1 trauma center. Though this requirement has been mandated for over a decade, its implementation has been challenging. Our research team completed an implementation study supporting seven pediatric trauma centers' compliance with the requirement by developing and implementing an institutional alcohol Screening, Brief Intervention and Referral to Treatment (SBIRT) policy for adolescent trauma patients. A mixed-methods approach indicated that SBIRT adoption rates increased at all sites; however, providers' fidelity to the SBIRT intervention was variable, and providers reported a number of barriers to SBIRT implementation. The goal of this study is to conduct a fully powered type III hybrid effectiveness-implementation trial to test the effectiveness of a comprehensive implementation strategy in increasing the implementation of SBIRT for alcohol and other drug use (AOD) in pediatric trauma centers.

Methods: Our implementation strategy is based on the Science to Service Laboratory (SSL), an approach developed by the SAMHSA-funded Addiction Technology Transfer Centers that consists of three core elements (i.e., didactic training + performance feedback + leadership coaching). Utilizing a stepped wedge design, a national cohort of 10 pediatric trauma centers will receive the SSL implementation strategy. At six distinct time points, each of the 10 sites will provide data from 30 electronic medical records (n = 1800 in total). A subset of adolescents will also report on fidelity of intervention delivery and linkage to care (i.e., continued AOD discussion and/or treatment with a primary care provider) 1 month after hospital discharge. In addition, nurses, social workers, and leaders will report on organizational readiness for implementation at four distinct time points.

Discussion: This protocol proposes a unique opportunity to examine whether a comprehensive implementation strategy can improve the fidelity of SBIRT delivery across a national cohort of pediatric trauma centers. With injured adolescents, this could optimize the detection and intervention of AOD use and improve adolescent health.

Trial registration: Clinicaltrials.gov NCT03297060 .

Keywords: Alcohol; Drugs; Pediatrics; SBIRT implementation; Trauma center.

Conflict of interest statement

Ethics approval and consent to participate

IAMSBIRT will utilize a single IRB, and the Lifespan-Rhode Island Hospital IRB has agreed to serve as the IRB of record for all participating sites. The Lifespan-Rhode Island Hospital IRB has approved this study for Rhode Island Hospital to serve as a participating (recruiting) site and also as the coordinating data center for the study. Any protocol modifications will be reviewed and approved by the Lifespan-Rhode Island Hospital IRB and reviewed with participating sites. The standing Data and Safety Monitoring Board (DSMB) of the Department of Emergency Medicine of the Warren Alpert School of Medicine of Brown University will serve as the DSMB for this study. The IAMSBIRT clinical trial has been registered with clinicaltrails.gov (NCT03297060).

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Implementing Alcohol Misuse Screening, Brief Intervention and Referral to Treatment (IAMSBIRT) stepped wedge design and timeline. Usual care is denoted as a solid blank square and signifies a time period of 9 months. Preparation stage is denoted as a box with diagonal lines and signifies a time period of 3 months. Implementation stage is denoted as a solid gray box and signifies a time period of 6 months. The sustainability stage is denoted as a solid black box and signifies a time period of 9 months
Fig. 2
Fig. 2
Specific elements of the Science to Service Laboratory (SSL) implementation strategy

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