Implementing Alcohol Misuse Screening Brief Intervention Referral to Treatment (IAMSBIRT)
Principal Investigator: Michael Mello, MD
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 screening, brief intervention and referral for treatment (SBIRT) for alcohol and other drug use (AOD) in pediatric trauma centers. 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.
This protocol provides 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.
Past Research Projects
The Injury Prevention Center has been conducting ongoing research for a number of years to determine how best to eradicate unnecessary injuries by evaluating the efficacy of our programs.
Advancing Patient Safety Implementation through Pharmacy-Based Opioid Medication Use Research is funded through a grant from the Agency for Healthcare Research and Quality (AHRQ). The goal of this study is to apply a systems-level approach to reducing harm of opioid-related adverse events by acknowledging the inherent need to manage opioid medication use more safely, and prepare patients for the possibility of opioid-induced adverse events.
Researchers: Michael Mello, MD, MPH; Ted Nirenberg, PhD; Andrew Nathanson, MD; Amy Rosenthal, MPA, and Lynn Sweeney
Supported by funding from the University Emergency Medicine Foundation, this study examined the role of alcohol in boating in Rhode Island. A survey of 1,000 registered Rhode Island boat owners found that 33 percent of boat operators and 44 percent of boat passengers consumed alcohol while boating during the month the survey was conducted. Given that exposure to environmental stresses causes a fatigue called "boater's hypnosis" and that alcohol impairs the senses, it is likely that the combination creates even more danger.
Although most states have laws about boating while under the influence of alcohol, these are not well known to boaters. Only 20 states require boating safety education prior to operating a boat, with those programs generally addressing the alcohol use of boat operators, not passengers.
This study demonstrates the need for better education and enforcement of the laws on and dangers of boating and alcohol use-for both boat operators and passengers.
The e-Parenting study is funded by the U.S. National Institute on Alcohol Abuse and Alcoholism. This study seeks to test the feasibility and acceptability of an e-parenting skills intervention, and the effect of this intervention on alcohol use and alcohol-related negative consequences among adolescents recruited from two trauma centers.
We will randomize 75 pairs of injured adolescents (12 to 17 years old) and their parent to receive either standard trauma center care (a brief intervention with the adolescent) or standard trauma center care (a brief intervention with the adolescent), plus an e-parenting skills intervention consisting of a computerized intervention for parent skill building, a series of text messages and a web-based message board.
Researchers: Rob Partridge, MD; Marc Shapiro, MD, and David Gifford, MD
This study, funded by the Society for Academic Emergency Medicine and the John A. Hartford Foundation, used the setting of the emergency department to investigate functional decline in elders with minor injury.
The study population was comprised of independently functioning elderly patients with acute traumatic injury treated primarily by emergency physicians and discharged from the emergency department. Functional outcome was assessed at the time of injury and at a three-month follow-up. The study found that 7% of independent elderly patients discharged from the emergency department after a minor injury have a decline in their ability to perform activities of daily living. In addition, 22% have a decline in their instrumental activities of daily living.
Thus, even a minor injury for a highly functional elderly person may put him or her at risk for functional decline and loss of independence.
The Injury Prevention Center is conducting two studies which aim to decrease injury among Rhode Island motorcyclists.
The first project, supported by funding from the American Public Health Association's Traffic Safety Institute and designed in cooperation with CCRI's Motorcycle Education Program, is a web-based survey of new Rhode Island motorcyclists. The goal of the survey is to identify what things have the biggest effect on motorcyclists' safety choices (e.g. beliefs about social acceptability of helmet use; beliefs about consequences of not using safety equipment; etc.). This survey was completed by approximately 500 Rhode Island motorcyclists this spring. Analysis of results is ongoing, but is expected to inform future motorcycle safety education programs.
The second project, supported by a grant from the Department of Emergency Medicine, specifically examines ways to increase motorcycle helmet use. As Rhode Island is one of 27 states with a "partial" helmet law, non-legislative strategies are essential to increase helmet use by motorcyclists in this state. This project studies whether the technique of "brief motivational interventions" can result in increased helmet use by injured motorcyclists after a crash. Brief motivational interventions have been shown to be effective in helping people to stop smoking, decrease risky drinking, and wear seatbelts. Recruitment for this study is ongoing.
For questions regarding the motorcycle studies, please contact the principal investigator, Megan Ranney, MD at 401-444-2557.
Principal Investigator: Peter Monti, PhD
IPC Researchers: Michael Mello, MD, MPH, Janette Baird, PhD
Project ACT is a five-year research study conducted in partnership with Brown University. This study, funded by NIAAA, evaluates the effects of two different interventions (motivational interviewing with significant other participation vs. individual motivational interviewing) on reducing alcohol consumption and alcohol-related problems among adult patients presenting in the Rhode Island Hospital trauma unit who were either alcohol positive or met screening criteria for alcohol problems.
CO-PI: James Linakis, MD, PhD and Anthony Spirito, PhD
Project ASSESS will validate the NIAAA two-question screen for early detection of alcohol use and problems with 12-17 year olds in 15 U.S. pediatric emergency departments (PED). Youths 12-17 years (N=8000) presenting to participating PECARN PEDs will be enrolled over a 3.5-year period and will complete the two-question screen along with other alcohol and other drug and behavior surveys. A subset of participants will also complete one week or 12 and 24 month surveys. Responses from these youths will be used to assess the validity of the NIAAA two-question screen.
Researchers: Michael Mello, MD, MPH; Ted Nirenberg, PhD; Robert Woolard, MD; Janette Baird, PhD
Project DIAL is a three-year research study funded by the Centers for Disease Control. This study evaluates the effectiveness of brief motivational interviewing delivered by telephone on reducing motor vehicle crashes (MVC) and other negative consequences associated with alcohol use. Patients who are involved in a MVC are recruited into the study while being treated in the ED. All recruited patients are followed up 3 and 12 months after being seen in the ED to determine the longer-term effects of receiving motivational interviewing by telephone.
Project Integrate is a project funded by an Emergency Medicine Foundation grant in collaboration with the National Highway Transportation Safety Administration.
This two-year project tests community emergency medical physicians in-training on a tool for screening alcohol use in patients by increased screening in the emergency department.
In the second part of the research, half of the patients whose screening test shows they have alcohol-related problems will receive a brief intervention in the emergency department about alcohol use.
Researchers: Robert Woolard, MD; Ted Nirenberg, PhD; Bruce Becker, MD, Michael J. Mello, MD, MPH; Janette Baird, PhD
This four-year research study funded by NIAAA is designed to examine the effects of brief motivational interviewing (MI) intervention on reducing negative consequences and injuries associated with the conjoint use of alcohol and marijuana.
ReDIAL (Revisiting Decreasing Injuries from Alcohol) is a research project that explores how a brief telephone-delivered intervention may change alcohol use or home safety practices.
The study builds upon DIAL (Decreasing Injuries from Alcohol), a recently completed Injury Prevention Center project that also delivered a brief telephone intervention about alcohol use to emergency department patients. After three-month follow-up interviews, fewer instances of drinking and driving were found in those who received the telephone intervention, compared to a control group who did not receive it. The results were published in the June 2008 issue of Annals of Emergency Medicine.
ReDIAL will examine the effects of a more intensive telephone intervention for alcohol use. It will also test the effectiveness of a new home-safety telephone intervention method in reducing the risk of injuries around the home as a result of changes in home safety practices.
This study recruits emergency department patients who were admitted with injuries and can communicate in English or Spanish. As part of the study, researchers will also estimate the cost effectiveness of screening and delivering these interventions by phone and examine the mechanisms underlying behavioral changes.
Researchers: Richard Longabaugh, EdD; Robert Woolard, MD; Ted Nirenberg, PhD; Allison Minugh, PhD; Bruce Becker, MD, MPH; Patrick Clifford, PhD; Kathleen Carty, LICSW; Frank Sparadeo, PhD and Aruna Gogineni, PhD
Injury Prevention Center research has found that more than one-fifth of subcritically injured people who come to hospital emergency departments are intoxicated. And, a single alcohol-related emergency department visit is a strong predictor of continued problem drinking, alcohol-impaired driving and future injury. Therefore, a visit to an emergency department can be an excellent opportunity for intervention.
So, once the doctor has attended to the physical damage, what can be done to tackle the patient's drinking problem? In a study funded by the National Institute for Alcohol Abuse and Alcoholism, researchers from the Injury Prevention Center and Brown University Center for Alcohol and Addiction Studies demonstrated that injured patients with an alcohol use problem who received a brief motivational intervention in the emergency department, followed up by a booster session, significantly reduced their alcohol-related injuries and other negative consequences.
The researchers' theory is that the proximity of injury and intervention creates a "teachable moment," giving the interventionist an opportunity to help patients explore their drinking patterns and motivate them to plan to reduce negative consequences from drinking in the future.
The Seat Checks in Pediatric Practice (SCiPP) study has been funded by a grant from the Rhode Island Foundation. This goal of the study is to evaluate the benefit of offering the services of a certified child passenger safety technician within a pediatric practice.
The Safe Opioid Prescription Protocol (SOPP) study has been funded by the Centers for Disease Control and Prevention. This study will evaluate the effect of a protocol designed to increase physician and nurse awareness of risk factor for unintentional opioid overdose among injured trauma patients who are discharged home with a prescription for opioid pain medication. The protocol will also address safe use, storage and disposal of opioid medications with these patients.
SOS is funded by the AAA Foundation for Traffic Safety. The project involves developing an online curriculum to train emergency department physicians throughout Rhode Island about screening patients for alcohol use problems and, if needed, referring them for further counseling. A copy of the report can be found on www.aaafoundation.org.
It is an 18-month project that will track changes in physicians' knowledge and behaviors for one year.
Researchers: Andrew Nathanson, MD; Philip Haynes, MD, PhD, and Daniel Galanis, PhD
Prior to this study, the last major study of surfing injuries was published in 1987. Since then, surfboards have become lighter, new maneuvers have evolved and surfers are venturing into more dangerous wave breaks.
In this study, investigators developed an interactive, Internet-based survey on self-reported surfing injuries in order to establish the mechanisms, pattern and frequency of surfing-related injuries.
They found that most surfing injuries are lacerations and contusions, evenly divided between the head and neck region and the lower extremities. The majority of injuries are caused by the surfer's own board, the ocean floor or another surfer's board. Chronic injuries are mostly related to overuse of the upper extremity and paraspinous muscles, as well as ear, sinus and skin infections.
The study concludes that many injuries may be prevented by minor alterations in board design and by use of protective equipment.
Research and policy support the integration of alcohol screening and brief intervention services for adolescents within pediatric level 1 trauma centers. Such trauma centers are also required to have the capacity to identify individuals with risky alcohol use and provide appropriate intervention. However, barriers exist which prevent the incorporation of such services into practice.
Through funding from the Centers of Disease Control and Prevention, we conducted a research study aimed to increase the adoption, implementation and maintenance of alcohol screening and brief intervention services for injured adolescent patients in seven pediatric level 1 trauma centers throughout the country. Representatives from pediatric trauma centers participated in technical assistance components (online, in person and conference calls) to help their trauma centers develop, integrate and maintain adolescent alcohol screening and brief intervention services. The research team monitored and collected data to gain information about changes in these services.
The manual Implementation of Alcohol Screening, Brief Intervention and Referral to Treatment Policies in Pediatric Centers summarizes recommendations derived from this research study.