Document text
Principal Investigator: HEATHER J GOTHAM
Organization: EMORY UNIVERSITY
Fiscal Year: 2024
Award: $704,512
Funding agency: National Institute on Alcohol Abuse and Alcoholism
Rates of risky alcohol and drug use and alcohol and substance use disorders (AUDs/SUDs) are highest among
women during their reproductive years compared to other periods of the life course. AUDs and SUDs are
associated with significant and lifelong behavioral, mental, physical, and sexual and reproductive health (SRH)
consequences for women and disproportionately for racially and ethnically minoritized women and those living
in poverty. There is an urgent need for innovative methods to address alcohol and substance use in preventive
healthcare settings. Family planning (FP) clinics are a trusted care source and primary point of access for
women and serve as a safety net for structurally marginalized groups in the U.S. FP clinics are uniquely well-
suited, but entirely understudied, contexts for implementing and scaling integrated alcohol/drug use services.
While screening, brief intervention, and referral to treatment (SBIRT) is a widely accepted, evidence-based
intervention for alcohol use in primary care and mental health settings, little is known about the facilitators and
barriers to the uptake and sustainment of SBIRT in FP clinics. Even less is understood about telemedicine,
which has been rapidly rolled out for COVID-19, as a SBIRT delivery platform. Further, virtually no evidence
exists on effective organizational level implementation strategies to accelerate SBIRT’s adoption in FP.
We propose an explanatory, sequential, mixed methods study to evaluate SBIRT in an expansive FP
clinic network of a national SRH organization – a novel and highly impactful setting with a reach of a diverse
and largely socially disadvantaged population of reproductive-aged women at greatest risk for AUDs/SUDs.
Our integrated study draws upon the evidence-based implementation approach, Implementation and
Sustainment Facilitation (ISF), guided by the Consolidated Framework for Implementation Research and
Reach, Effectiveness, Adoption, Implementation and Maintenance models. In Aim 1, to identify specific targets
for implementation, sustainment, and scale-up of SBIRT, we will conduct administrative surveys with clinic
stakeholders (clinic directors, providers, and staff n=153) and key informant interviews with stakeholders and
patients (n=40) to investigate organizational practices and perspectives on alcohol- and substance-related
services. In Aim 2, we will conduct a dual randomized Type 1 Hybrid Effectiveness-Implementation trial testing
SBIRT (in-person and telemedicine) vs. usual care, within a large, high-volume Northeastern affiliate of the
national organization. We will randomize 600 patients across 4 clinics, collecting patient level data on alcohol
and substance use primary effectiveness outcomes, as well as secondary SRH, mental/physical health, quality
of life, and wellbeing outcomes at baseline, 30 days, and 3 months. Aim 3 will explore facilitators and barriers
to SBIRT adoption and the ISF implementation strategy via surveys and interviews with clinic directors,
providers, and staff (n=20) and patients (n=20) electronic medical records. Results will provide new, timely
evidence to inform scale-up of alcohol and substance related services in FP settings nationally.
Terms: <AIDS Virus><Academy><Acceleration><Access to Care><Acquired Immune Deficiency Syndrome Virus><Acquired Immunodeficiency Syndrome Virus><Address><Administrator><Adoption><Age><Alcohol Chemical Class><Alcohol Drinking><Alcohol consumption><Alcohols><Application Context><Behavioral><COVID crisis><COVID epidemic><COVID pandemic><COVID-19><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><CV-19><Caring><Clinic><Clinical><Community Health><Competence><Computerized Medical Record><Consolidated Framework for Implementation Research><Consolidated Framework for Implementation Science><Consolidated Framework for Implementing Change><Contraception><Contraceptive Agents><Contraceptive methods><Contraceptives><Coronavirus Infectious Disease 2019><Coupled><Data><Discipline of obstetrics><Disparities><Disparity><Disparity population><Drug Screening><Drug usage><Drugs><ETOH level><Electronic Medical Record><Equity><EtOH drinking><EtOH use><Ethnic Minority Women><Ethnic Origin><Ethnicity><Evidence based intervention><Family Planning><Family Planning Services><Female Health><Fertility Control><Forcible intercourse><Funding><Gender><Gestation><Groups at risk><HIV><Health><Health Inequity><Health Services Accessibility><Healthcare><Heavy Drinking><Human Immunodeficiency Viruses><Impoverished><Inequalities in Health><Inequities in Health><Infrastructure><Inhibition of Fertilization><Intervention><Intervention Strategies><Interview><Intoxication><LAV-HTLV-III><Life Cycle><Life Cycle Stages><Lymphadenopathy-Associated Virus><Maternal Mortality><Medicaid><Medical Electronics><Medication><Medicine><Mental Health><Mental Hygiene><Methods><Modeling><NIH><National Institutes of Health><Obstetrics><Outcome><Patients><People at risk><Personal Satisfaction><Persons><Persons at risk><Pharmaceutical Preparations><Populations at Risk><Poverty><Pregnancy><Preventative health care><Preventative healthcare><Preventive><Preventive health care><Preventive healthcare><Primary Care><Process><Process Measure><Provider><Psyche structure><Psychological Health><QOL><Quality of life><RE-AIM><Race><Races><Randomized><Rape><Reach, Effectiveness, Adoption, Implementation, and Maintenance><Records><Reporting><Reproductive Health><Research Resources><Resources><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><SBIRT><Services><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Sexually Transmitted Diseases><Sexually Transmitted Disorder><Sexually Transmitted Infection><Shapes><Site><Socio-economic status><Socioeconomic Status><Source><Substance Use Disorder><Survey Instrument><Surveys><System><Technology><Telemedicine><Testing><Training><Treatment Effectiveness><Trust><United States><United States National Institutes of Health><Unplanned pregnancy><Urbanicity><Venereal Diseases><Venereal Disorders><Venereal Infections><Violence><Virus-HIV><Visit><Woman><Women's Health><access to health services><access to services><access to treatment><accessibility to health services><aged><aged group><aged groups><aged individual><aged individuals><aged people><aged person><aged persons><aged population><aged populations><ages><aging population><alcohol ingestion><alcohol intake><alcohol level><alcohol measurement><alcohol product use><alcohol risk><alcohol screening><alcohol use><alcohol use disorder><alcoholic beverage consumption><alcoholic drink intake><availability of services><behavioral health><care access><care as usual><community-based health><condoms><contextual factors><coronavirus disease 2019><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><coronavirus infectious disease-19><disadvantaged group><disadvantaged individual><disadvantaged people><disadvantaged population><disadvantaged subgroup><disparities across groups><disparity across subgroups><disparity among groups><disparity among subgroups><disparity between groups><disparity between subgroups><drink heavily><drug use><drug/agent><effectiveness and implementation trial><effectiveness measure><effectiveness outcome><effectiveness testing><effectiveness-related outcomes><effectiveness/implementation hybrid trial><effectiveness/implementation trial><ethanol consumption><ethanol drinking><ethanol ingestion><ethanol intake><ethanol measurement><ethanol product use><ethanol use><ethanol use disorder><ethnic minority><ethyl alcohol measurements><evidence base><excessive alcohol consumption><excessive alcohol ingestion><excessive alcohol intake><excessive drinking><excessive ethanol ingestion><experience><extreme drinking><forced sex><group disparity><group inequality><group inequity><health care><health care organization><health care service organization><health care settings><health equity><health inequalities><health organization><health service access><health services availability><healthcare organization><healthcare service organization><healthcare settings><heavy alcohol use><hybrid type 1 trial><hybrid type I trial><illicit drug use><implementation facilitation><implementation science><implementation strategy><implementation trial><improved><inequalities among populations><inequalities between populations><inequalities in populations><inequality across populations><inequality among groups><inequality between groups><inequality in groups><inequities among populations><inequities between populations><inequities in populations><inequity across groups><inequity across populations><inequity between groups><inequity in groups><infant morbidity/mortality><informant><innovate><innovation><innovative><interventional strategy><life course><marginalization><marginalized group><marginalized individual><marginalized people><marginalized population><maternal death><maternal morbidity><mental><multidisciplinary><novel><pandemic><pandemic disease><patient centered><patient oriented><physical conditioning><physical health><population aging><population inequality><population inequity><public health relevance><racial><racial background><racial minority group><racial minority individual><racial minority people><racial minority population><racial minority women><racial origin><randomisation><randomization><randomly assigned><reach, efficacy, adoption, implementation, and maintenance><reproductive><response><safety net><scale up><screening, brief intervention, and referral to treatment><screening, brief intervention, referral, and treatment><service availability><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><sex><sexual and reproductive health><sexually acquired infection><social disadvantage><social disparities><social inequality><social stress><socially stressed><socio-demographics><socio-economic position><sociodemographics><socioeconomic position><stakeholder insights><stakeholder perspectives><strategies for implementation><subgroup disparity><substance use><substance use and disorder><substance using><treatment access><treatment as usual><under served community><underserved community><unequal group><unequal population><unintended pregnancy><uptake><usual care><violent><violent behavior><virtual><well-being><wellbeing>