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Implementation Science
Published in: Implementation Science 1/2018

Open Access 01-12-2018 | Study protocol

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

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

Published in: Implementation Science | Issue 1/2018

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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.
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Metadata
Title
Implementing Alcohol Misuse SBIRT in a National Cohort of Pediatric Trauma Centers—a type III hybrid effectiveness-implementation trial
Authors
Michael J. Mello
Sara J. Becker
Julie Bromberg
Janette Baird
Mark R. Zonfrillo
Anthony Spirito
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2018
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/s13012-018-0725-x

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