Reducing Alcohol and Opioid Use Among Youth in Rural Counties: An Innovative Training Protocol for Primary Health Care Providers and School Personnel

Background Given that youth alcohol use is more common in rural communities, such communities can play a key role in preventing alcohol use among adolescents. Guidelines recommend primary care providers incorporate screening, brief intervention, and referral to treatment (SBIRT) into routine care. Objective The aim is to train primary care providers and school nurses within a rural 10-county catchment area in Pennsylvania to use SBIRT and facilitate collaboration with community organizations to better coordinate substance use prevention efforts. Methods To build capacity to address underage drinking and opioid use among youth aged 9-20 years, this project uses telehealth, specifically Project ECHO (Extension for Community Healthcare Outcomes), to train primary care providers and school nurses to address substance use with SBIRT. Our project will provide 120 primary care providers and allied health professionals as well as 20 school nurses with SBIRT training. Community-based providers will participate in weekly virtual ECHO sessions with a multidisciplinary team from Penn State College of Medicine that will provide SBIRT training and facilitate case discussions among participants. Results To date, we have launched one SBIRT ECHO project with school personnel, enrolling 34 participants. ECHO participants are from both rural (n=17) and urban (n=17) counties and include school nurses (n=15), school counselors (n=8), teachers (n=5), administrators (n=3), and social workers (n=3). Before the study began, only 2/13 (15.5%) of schools were screening for alcohol use. Conclusions This project teaches primary care clinics and schools to use SBIRT to prevent the onset and reduce the progression of substance use disorders, reduce problems associated with substance use disorders, and strengthen communities’ prevention capacity. Ours is an innovative model to improve rural adolescent health by reducing alcohol and opioid use. International Registered Report Identifier (IRRID) DERR1-10.2196/21015


Review Resume
This application was reviewed by a SAMHSA Peer Review Committee to provide an objective assessment of the merit of the applicant organization's response to the Evaluation Criteria published in the funding announcement (FOA).
The Section scores will have the following verbal descriptors: Outstanding = All criteria are thoroughly addressed, strongly developed, and well supported.Documentation and required information are specific and comprehensive.Application is extremely strong with insignificant weaknesses.Weaknesses identified will likely have no impact on the successful implementation of the proposed project.
Very good = Criteria are thoroughly addressed with necessary detail and clearly supported.Documentation and required information are specific and feasible.Application is very strong with only some minor weaknesses.Weaknesses identified will likely have minor impact on the successful implementation of the proposed project.Acceptable = Criteria are addressed, but do not contain necessary detail and/or support.Most documentation and required information are present and sufficient, although some are deficient or missing.Application has some strengths but with at least one major weakness.Weaknesses identified will likely have moderate impact on the successful implementation of proposed project.
Marginal = Some criteria are addressed, although when addressed, do not contain necessary detail and/or support.Some documentation and required information are missing or deficient.Application has a few strengths and a few major weaknesses.Weaknesses identified will likely impact the successful implementation of the proposed project.Unacceptable = Few, if any, criteria are addressed.Documentation and required information are missing.Application has very few strengths and numerous major weaknesses.Weaknesses identified will likely prevent the successful implementation of the proposed project.

OR
The criteria do not meet the programmatic intent of the Funding Opportunity Announcement.In this Section of the Project Narrative, the applicant organization must identify where the project will be implemented and the population(s) that will be impacted by the infrastructure development in the targeted systems or agencies.The applicant organization must document the need for enhanced infrastructure to increase the capacity to implement, sustain, and improve effective substance abuse prevention services in the proposed catchment area that is consistent with the purpose of the FOA.It must identify any substances other than alcohol that it will address in the project.Furthermore, it must describe the extent of the problem in the catchment area, including service gaps, and document the extent of the need (i.e., current prevalence rates or incidence data) for the population(s) of focus identified.X the population(s) that will be impacted by the infrastructure development in the targeted systems or agencies X the proposed catchment areas where the project will be implemented X Extensive documentation is provided on the need for an enhanced infrastructure to increase the capacity to implement, sustain, and improve effective substance abuse prevention services in the proposed catchment areas that is consistent with the purpose of the FOA.X If applicable, identifies any substances other than alcohol that it will address in the project.X The service gaps and other problems related to the need for infrastructure development are thoroughly discussed.X Data sources are identified.

Overall Assessment of Section A: Population of Focus and Statement of Need
Additional comments: None.

Weaknesses:
The narrative does not clearly identify: the population(s) that will be impacted by the infrastructure development in the targeted systems or agencies the proposed catchment areas where the project will be implemented The population of focus does not align with the intent of the FOA.Substantive documentation is not provided on the need for an enhanced infrastructure to increase capacity to implement, sustain, and improve effective substance abuse prevention services in the proposed catchment area that is consistent with the purpose of the FOA.If applicable, substances other than alcohol that will be addressed in the project are not identified.