(37) Adolescent Addiction Medicine Tele-Consult Services within School-Based Health Centers

INTRODUCTION/BACKGROUND; School based health centers (SBHCs) are comprehensive primary care facilities that reduce barriers to education by providing in-school access to healthcare. Students enrolled in SBHCs can access confidential healthcare independently during school hours – making SBHCs an ideal setting to address substance use. SBHC providers report lack of time, training, and treatment access as implementation barriers to screening, brief intervention, and referral to treatment (SBIRT) for alcohol and other substance use. We describe the implementation of a novel telemedicine-based adolescent addiction medicine consult service for middle and high school students within SBHCs.

METHODS; In January 2020, the Yale Program in Addiction Medicine, Fair Haven Community Health Care (FHCHC; a federally qualified health center), and Yale Department of Pediatrics partnered to integrate substance use screening, treatment, and prevention services into pediatric primary care. FHCHC provides medical and behavioral healthcare to over 18,000 pediatric patients across 14 sites, including 6 middle and high school based SBHCs. From January to March 2020, the SBHC providers, leadership from pediatrics, and a pediatrician board certified in addiction-medicine used a partnered, consensus building approach to establish an SBHC-integrated adolescent addiction medicine outpatient consult service. Protocols were created to standardize: 1) Referral criteria (at risk for suspension due to substance use (including vaping), positive screen for substance use, ≥ monthly use of any substance); 2) referral and scheduling (EHR-based referral system, direct scheduling of appointments); 3) overall principles of care (up to 6 sessions of voluntary and confidential care, encouraging parental involvement and linkage to ongoing mental health and substance use treatment services); 4) infrastructure needs (tele-video enabled, internet-connected device, private room in the SBHC for patient); 5) staffing needs (one pediatric addiction medicine specialist, one SBHC healthcare provider, and one support staff); and 6) SBHC training needs (education on best practices for screening, how to describe service to students, parents and administrators). Given the ongoing COVID-19 pandemic and local addiction medicine workforce capacity, the service was designed to occur via telemedicine with a pediatrician board-certified in addiction medicine or a family-medicine-trained addiction medicine fellow.

RESULTS; Starting in March 2020, Adolescent Addiction Medicine Tele-Consult Services were available during one four-hour block/week when school was in session. Between March 2020 and December 2021, the service completed 57 encounters with 25 adolescents aged 13-18 years. Telemedicine encounters lasted 20-40 minutes and the student completed the visit in a private room within the SBHC during school hours. Services included: diagnosis of substance use disorders, psychoeducation, referral to and coordination with mental health services, nicotine use disorder treatment with medications, harm reduction and return to use prevention counseling. Diagnoses included: Nicotine use disorder (vaping) (n=9 patients), cannabis use disorder (n=5), alcohol use (n=7), nicotine use (n=8), cannabis use (n=11) and prescription opioid misuse (n=2).

CONCLUSION; Here we describe the development and early implementation of an Adolescent Addiction Medicine Tele-Consult Service within SBHCs. Next steps for program development include formal tracking of patient-level outcomes, evaluations of acceptability among adolescents, SBHCs and schools, and further development of training opportunities for residents and fellows.

References: 1. Knopf JA, Finnie RK, Peng Y, Hahn RA, Truman BI, Vernon-Smiley M, Johnson VC, Johnson RL, Fielding JE, Muntaner C, Hunt PC, Phyllis Jones C, Fullilove MT; Community Preventive Services Task Force. School-Based Health Centers to Advance Health Equity: A Community Guide Systematic Review. Am J Prev Med. 2016 Jul;51(1):114-26. doi: 10.1016/j.amepre.2016.01.009. PMID: 27320215; PMCID: PMC5759331.3.

2. Harris B, Shaw B, Lawson H, Sherman B. Barriers to Addressing Adolescent Substance Use: Perceptions of New York School-Based Health Center Providers. J Sch Health. 2016 Feb;86(2):96-104. doi: 10.1111/josh.12358. PMID: 26762820.

3. -Soleimanpour S. School-Based Health Centers: At the Intersection of Health and Education. J Adolesc Health. 2020;67(3):317-318. doi:10.1016/j.jadohealth.2020.05.009