Improving Adolescent Primary Care Through An Interactive Behavioral Health Module - 2011

Summary: Most adolescents visit a health care provider once a year, providing an opportunity to integrate behavioral/emotional health screening into clinical care. Yet despite clinical guidelines, providers screen adolescents for risky health behaviors and depression at rates consistently lower than recommended. Therefore, new strategies are needed to increase behavioral health screening in primary care. Health information technology (IT), such as an electronic health record with clinical decision support (CDS), has tremendous potential to improve health care quality and subsequent behavioral health outcomes for adolescents. Many adolescent health problems are amenable to behavioral intervention, and most teenagers are comfortable using interactive computerized technology, yet few health IT interventions have been integrated into adolescent care.

This exploratory project is developing a theoretically-based interactive behavioral/emotional health module for adolescents that can be integrated into health care delivery, serving as both a risk assessment and an intervention tool to enhance adolescent behavior change. After the module has been developed, it will be piloted in adolescent primary care practices, assessing clinician, adolescent, and system outcomes. The study is being conducted within the San Francisco Bay Collaborative Research Network (CRN) through the University of California, San Francisco (UCSF). From these ethnically- and economicallydiverse clinics, a sample of adolescents ages 12 to18 years will be recruited to participate. Multiple approaches and data sources will be utilized to conduct quantitative and qualitative analyses on each of the outcomes of interest.

The overarching goal of this project is to better understand how the proposed intervention addresses the diverse needs of teenagers, informs the contextual factors that contribute to quality of implementation in varied clinic contexts, and informs strategies for adaptation and integration in larger scale health IT implementation. Ultimately, this project will help inform the development and implementation of health information tools into the primary care setting while also focusing on technology that supports patient-centered care.

Specific Aims:

• Develop a theoretically-based interactive behavioral/emotional health module for adolescents that can be integrated into health care delivery, serving as both a risk assessment and an intervention tool to enhance adolescent behavior change. (Ongoing)
• Pilot-test the implementation of the computerized module/screening system in adolescent primary care, assessing clinician, adolescent, and system outcomes. (Upcoming)

2011 Activities: During the first quarter, the project staff focused on: 1) reviewing existing interactive modules to determine appropriateness of materials for application to development of this particular behavioral health module; 2) contacting medical directors and other key staff in clinics that have expressed support for involvement in development and integration of the intervention module in their clinic site; and 3) obtaining institutional review board approval for the research project from the Committee on Human Research at UCSF.

The study team continues to communicate regularly with UCSF colleagues to discuss adaptation and options for development of the adolescent health module, as well as the details of module development and building off their existing adolescent screening tool. In addition, the team is investigating how a screening tool might be integrated broadly within the new UCSF electronic medical record system.

As last self-reported in the AHRQ Research Reporting System, project progress and activities are on track, and project budget spending is on target.

Preliminary Impact and Findings: This project has no findings to date.

Target Population: Pediatric*, Teenagers

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve health care decisionmaking through the use of integrated data and knowledge management.

Business Goal: Knowledge Creation

* This target population is one of AHRQ's priority populations.