Developing a Screening Tool for Young Children Using an Ecological Framework.

Young children from impoverished backgrounds experience high levels of family and environmental stress, adversely impacting developmental functioning. Early identification provides a pathway to solutions, but many children are never assessed. In addition, the child-serving workforce lacks resources and expertise to use traditional measures. Furthermore, existing measures do not account for the substantial influence of a child's ecology. To bridge these gaps, we developed the Neurodevelopmental Ecological Screening Tool (NEST) and conducted a pilot study (n=60) to test its feasibility for use with caregivers of children ages 3-5 in low-resource settings. We developed an item pool across three domains (child, caregiver, environment), vetted it with experts, and conducted cognitive interviewing with parents (n=15) and case managers (n-10). Simultaneously, we built an online, user-friendly delivery platform. We used a one parameter Item Response Model and a Rasch-based Rating Scale Model (RSM) and fit confirmatory factor analytic (CFA) models to test for unidimensional and construct validity. The results support the feasibility of screening children from low SES populations within low-resource settings using an ecological perspective and supports the work of child-serving paraprofessionals in identifying and addressing risks in the lives of young children.

Enhancing adolescent SBIRT with a peer-delivered intervention: An implementation study.

PURPOSE: Innovations in adolescent prevention and early intervention strategies are needed to curb early substance use and bring public health models to scale, such as Screening, Brief Intervention, and Referral to Treatment (SBIRT). Young adults in recovery may have an important role to play in delivering these innovations. However, clinics, schools, and community programs may face barriers when implementing new prevention and early intervention approaches in their settings. The purpose of this study is to examine the feasibility, barriers, and facilitators of Project Amp, an innovative, four-session prevention and early intervention model to enhance SBIRT for adolescents. METHODS: Three school-based programs and three health clinics were selected to implement SBIRT for adolescents and refer eligible adolescents (13-17 years old, moderate risk for substance use disorder) to the study intervention. Between three and six mentors (young adults, 18-28 years old, with lived experience of substance use recovery, also known as peers), were recruited at each site and trained in core skills to deliver the intervention. Study staff communicated with each setting throughout implementation and collected quantitative and qualitative data regarding facilitators and barriers to success. The qualitative data were analyzed to identify key strategies for success when implementing Project Amp. RESULTS: Across the six sites, 71 practitioners including physicians, nurses, social workers, and counselors, completed training in SBIRT and 30 mentors were hired and trained for the study. Twenty completed sessions with adolescent participants. A total of 1192 adolescents were screened using the CRAFFT. Of those screened, 139 (12%) were eligible, 51 eligible youth (37%) enrolled in the study, and 28 enrolled youth (55%) completed the intervention. Five of the six sites were successfully able to integrate the SBIRT-based Project Amp model into their workflow. Facilitators and barriers for implementation were identified related to three critical factors: recruitment, readiness, and sustainability. CONCLUSIONS: The Project Amp intervention can be conducted successfully in school and healthcare settings in conjunction with SBIRT, adding capacity to expand access to screening and early intervention in a developmentally appropriate way. However, the study yielded insights into adaptations for future implementation, such as a more streamlined model and centralized staff roles such as integrated roles for young peer mentors.

A framework for integrating young peers in recovery into adolescent substance use prevention and early intervention.

Substance use among adolescents is associated with a range of negative outcomes and risk-taking behaviors. Identifying and intervening early is essential to reducing associated risks in adolescence and adulthood. New approaches are needed to equip youth-serving systems with tools to identify and respond to substance use. Screening, Brief Intervention, and Referral to Treatment (SBIRT) has emerged as a promising public health framework and there is a growing research interest in effective adaptations for its use with adolescents. However, healthcare settings, schools, and other community-based settings are slow to adapt SBIRT, citing gaps in knowledge and capacity to deliver evidence-based substance use prevention and early intervention. Further, these settings and the surrounding communities often lack the treatment and other prevention and recovery support resources needed for youth who screen as high-risk. Integrating young adult peers with personal lived experience of substance use recovery may meet this practical need. By drawing upon their shared experiences and skills developed in recovery, young adult peers can provide developmentally appropriate screening and intervention support to youth - while also providing urgently needed skills and time to under resourced settings. This article describes the value of young adult peer roles in expanding youth substance use prevention and early intervention, and features Project Amp as an example. Project Amp was designed as an extended, four-session brief intervention for low to moderate risk adolescents, delivered by trained young adult peers. Project Amp draws on best practices from peer recovery support and prevention and early intervention approaches such as SBIRT.