Health-promotion advocates in the pediatric emergency room serve as a vital resource for young people experimenting with substances, and link them with critical resources and treatment, according to a new study by researchers from Boston Medical Center and the School of Public Health.
The American Academy of Pediatrics recommends that all adolescents be screened for substance use, emotional well-being, risk reduction, and violence and injury prevention as part of their routine checkups with a pediatrician. But adolescents have some of the lowest visitation rates to primary care doctors for regular check-ups among all age groups in the US. As a result, many teens rely on emergency rooms for both urgent and non-urgent medical care.
“We know that adolescence is a critical period for brain development, and substance use experimentation puts teens at risk for injury and poor school performance,” said Edward Bernstein, emergency medicine physician and director of Project Assert at BMC, who served as the study’s senior author. “The pediatric emergency room presents a unique opportunity to discuss and promote prevention and link teens to treatment.”
Health promotion advocates are trained in identifying health and safety needs, enhancing motivation for change, and providing a menu of resources. Over four years, health-promotion advocates screened 2,149 pediatric emergency room patients at BMC, aged 14 to 21, for risky behaviors such as binge drinking, violence, unprotected sex, and drug use. Thirty-seven percent screened positive for drug or alcohol use, and of that group, 81 percent participated in an intervention that encouraged change.
Once teens screened positive, the advocates had conversations with them about the risks associated with substance use and referred them to primary care physicians or substance use treatment services, including outpatient counseling, community support programs, and detox units.
“Our goal was to provide comprehensive, preventive services to at-risk teens in a way that could be integrated into the existing model of care,” said Judith Bernstein, professor of community health sciences and emergency medicine at SPH and the School of Medicine, who served as the study’s corresponding author. “It was essential that the advocates look beyond the substance use and address the underlying behaviors of these teens, in order to effectively and successfully promote a positive change.”
Researchers said the advocates were essential to helping pediatric emergency room patients navigate preventive support services for substance use and extend the scope of pediatric ER teams. They said future research is needed to determine the long-term benefits of the intervention.
The study, published in the Journal of Pediatric Emergency Care, was supported in part by a grant from the Massachusetts Department of Public Health, Bureau of Substance Abuse Services.
Study collaborators include: David Dorfman, chief of the division of pediatric emergency medicine at BMC and associate professor of pediatrics at MED; Deric Topp, assistant director of the BNI-ART Institute at SPH; Hosana Mamata and Sara Jaffer of the Department of Community Health Sciences at SPH; and Julie Lunstead, project manager for the Adolescent Substance Abuse Program at Boston Children’s Hospital.