Computer adaptation of screening, brief MET intervention to reduce teen drinking

计算机适应筛查、简短的 MET 干预以减少青少年饮酒

• 批准号: 8684407
• 负责人: Sion Kim Harris
• 金额: $ 25万
• 依托单位: BOSTON CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2017-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8684407
• 关键词: Accidents; Adolescent; Adult; Age; Alcohol consumption; Alcohol or Other Drugs use; Alcoholism; Automobile Driving; Behavioral; Cannabis; Cause of Death; Childhood; Clinic; Communication; Computers; Development; Drug usage; Early Intervention; Effectiveness; Electronic Mail; Electronics; Evaluation; Exercise; Family; Gender; Goals; Health; Health Care Visit; Health Promotion; Home environment; Homicide; Intention; Intervention; Left; Link; Manuals; Measurement; Measures; Mediator of activation protein; Medical; Mental Health; New England; Notification; Odds Ratio; Outcome; Outpatients; Patients; Pilot Projects; Prevalence; Prevention; Primary Health Care; Professional counselor; Protocols documentation; Provider; Questionnaires; Randomized; Recording of previous events; Recruitment Activity; Relative Risks; Research; Risk; Sampling; Sampling Studies; Savings; Secure; Self Efficacy; Series; Staging; Standardization; Substance abuse problem; Suicide; System; Teenagers; Testing; Time; Tobacco; Training; Treatment Cost; Visit; Youth; adolescent substance abuse; alcohol intervention; alcohol screening and brief intervention; base; behavior change; binge drinking; brief advice; brief screening; computerized; demographics; drinking; effectiveness trial; experience; follow-up; improved; intervention effect; motivational enhancement therapy; older patient; peer; pilot trial; preference; prevent; primary care setting; programs; provider intervention; public health relevance; randomized trial; response; routine care; satisfaction; screening; screening and brief intervention; standard care; therapy development; treatment adherence; treatment as usual; treatment program; trial comparing; underage drinking

DESCRIPTION (provided by applicant): The goal of this project is to evaluate the feasibility, acceptability, and effect size of a new computerized Motivational Enhancement Therapy (cMET) intervention for alcohol-involved adolescents in primary care. We previously developed a computerized screening and provider brief advice system for primary care, and compared it to treatment as usual (TAU) among 2096 12- to 18-yr-old patients. We found a large reduction in overall drinking rates at 3-months for the active condition versus control and the effect was still detectable at 12-months. Nonetheless, the majority of baseline drinkers continued to drink, demonstrating the need for a more robust intervention than provider brief advice alone. In a parallel line of research, we adapted Motivational Enhancement Therapy (MET) to be developmentally-appropriate for adolescents and practical for delivery in 2- to 3-sessions by a trained counselor in busy outpatient medical settings, and conducted a randomized trial comparing standard care (SC) vs. SC+MET among 12- to 21-yr-olds (N=140) in our outpatient substance abuse evaluation and treatment program. We found that SC+MET patients had significantly greater treatment adherence and reduced rates of driving and riding risks during the 9-month follow-up. To promote its transferability to primary care settings that reach many more adolescents, we created an interactive, computerized version of MET (cMET) with customizable avatars for the teen and clinicians, interactive electronic versions of all MET worksheets, and secure patient-clinician email communication and notifications. The program also generates monthly provider-to-teen health-promotion messages to extend the intervention effect over time. The cMET program is completed in two <1-hr sessions; the first completed adolescents will complete as soon as possible after the medical visit, and the second 2 weeks later on a private computer at home or elsewhere. Patients return for a check-in visit with their provider 4 weeks after completing session 2. We are now prepared to conduct a Stage-1 randomized controlled pilot study of the cMET system, with its enhanced standardization and efficiency, compared to treatment as usual, among 14- to 20-yr-old screen+ primary care patients. Our study aims are to: 1) Assess cMET feasibility and acceptability and estimate its effect size on underage drinking. Feasibility: teen completion of cMET exercises, cMET sessions 1 and 2, and follow-up visits; Acceptability: adolescent and provider satisfaction; Effect Size Estimate: compare cMET vs. TAU rates of alcohol use at 3-, 6-, and 9-month follow-ups. Hypothesis: Among 14- to 20-yr-old primary care patients, those receiving cMET will have lower rates of any alcohol use, days of alcohol use, drinks per drinking day, and days of heavy episodic drinking, than those receiving treatment as usual. 2) Estimate effect sizes for tobacco, cannabis, and other drug use, and other substance-related risks and outcomes. 3) Identify potential moderators and mediators of cMET's effect.

描述（由申请人提供）：该项目的目的是评估针对初级保健中酒精涉及的青少年的新计算机动机增强疗法（CMET）干预的可行性，可接受性和效果大小。我们之前曾开发了一种计算机化筛查和提供者简短的初级保健建议系统，并在2096年12至18岁的患者中将其与往常一样（TAU）进行了比较。我们发现，有效状况与对照的3个月时，总体饮酒率大幅度降低了，效果仍然是 可在12个月内检测到。但是，大多数基线饮酒者继续喝酒，这表明与仅提供者的简短建议相比，需要进行更强大的干预措施。在一项平行研究中，我们改编了动机增强疗法（MET），在繁忙的门诊医疗环境中，经过训练的辅导员在2至3次的时间内进行开发，在2至3个课程中进行交付，并进行了一个随机的门诊医疗机构，并进行了一个随机的试验比较标准护理（SC）vs. sc+Met的虐待，在12-至21-11-11-元素范围内（N = 140）（n = 140）（我们）在我们的范围内进行了比较。我们发现，在9个月的随访期间，SC+MET患者的治疗依从性明显更高，驾驶风险和骑行风险率降低。为了促进其转移到更多吸引更多青少年的初级保健环境中，我们创建了一个互动的，计算机化的MET（CMET），该版本（CMET）使用可自定义的青少年和临床医生，所有MET工作表的交互式电子版本，并确保患者临床的电子邮件通信和通知。该计划还会生成每月至少的健康促进消息，以扩展干预效果。 CMET程序在两个<1小时的课程中完成；医疗访问后，第一个完整的青少年将尽快完成，第二个两周后，在家里或其他地方的一台私人计算机上。在完成第2次会议后4周，患者返回与提供商的登机手续访问。我们现在准备对CMET系统进行1阶段的随机对照试验研究，其标准化和效率增强，与往常相比，在14至20年历史的筛查+初级保健患者中。我们的研究目的是：1）评估CMET的可行性和可接受性，并估计其对未成年人饮酒的影响。可行性：CMET练习的青少年完成，CMET会议1和2，然后访问；可接受性：青少年和提供者满意度；效应大小的估计值：比较3，6和9个月的随访中的CMET与TAU饮酒率。假设：在14至20岁的初级保健患者中，与像往常一样接受治疗的人的酒精使用率，每天饮酒，每天喝酒的天数，每天喝酒的饮料和大量的发作性饮酒率都较低。 2）烟草，大麻和其他药物使用以及其他与物质有关的风险和结果的估计效应大小。 3）确定CMET效应的潜在主持人和介体。