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Application of System Dynamics to Inform a Model of Adolescent SBIRT Implementation in Primary Care Settings

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Abstract

System dynamics (SD) modeling is used to compare and contrast strategies for effective implementation of an evidence-based adolescent behavioral health treatment in primary care settings. With qualitative and quantitative data from an on-going cluster-randomized trial in 7 federally qualified health center sites, two implementation conditions were compared: generalist vs. specialist. In the generalist approach, the primary care provider (PCP) delivered brief intervention (BI) for substance misuse (n = 4 clinics). In the specialist approach, BIs were delivered by behavioral health counselors (BHCs) (n = 3 clinics). The resultant SD model compared ‘basecase’ dynamics to strategic approaches to deploying continuous technical assistance (TA) and performance feedback reporting (PFR). The basecase effectively represented the SBIRT intervention, which reflected actual monthly volume of adolescent primary care visits (N = 9639), screenings (N = 5937), positive screenings (N = 246), and brief interventions (BIs; N = 50) over the 20-month implementation period. Insights gained suggest that implementation outcomes are sensitive to frequency of PFR, with bimonthly events generating the most rapid and sustained screening results. Simulated trends indicated that availability of the BHC directly impacts success of the specialist model. Similarly, understanding PCPs’ perception of severity of need for intervention is key to outcomes in either condition.

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Acknowledgments

We thank Ms. Faye Royale-Larkins and the staff of Total Health Care for their collaboration on this project. We also thank Ms. Tinika Christopher for her help with manuscript preparations and Drs. Tisha Wiley and Lori Ducharme for their continued guidance in this work.

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Authors and Affiliations

  1. Montefiore Medical Center, Division of Community Collaboration and Implementation Science, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA

    David William Lounsbury PhD

  2. Friends Research Institute, Baltimore, MD, USA

    Shannon Gwin Mitchell PhD, Kristi Ann Dusek MDiv, Robert P. Schwartz MD, Jan Gryczynski PhD, Laura B. Monico PhD & Barry S. Brown PhD

  3. College of Global Public Health, New York University, New York, NY, USA

    Josh Zhi Li MPH

  4. Total Health Care, Baltimore, MD, USA

    Arethusa S. Kirk MD, FAAP

  5. The Mosaic Group, Baltimore, MD, USA

    Marla Oros RN, MS

  6. University of Maryland Baltimore County, Baltimore, MD, USA

    Colleen Hosler MA

  7. University of North Carolina at Wilmington, Wilmington, NC, USA

    Barry S. Brown PhD

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  1. David William Lounsbury PhD
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  2. Shannon Gwin Mitchell PhD
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Correspondence to David William Lounsbury PhD.

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Conflict of Interest

No financial disclosures were reported by the authors. Dr. Kirk was Vice President of Medical Affairs and a practicing pediatrician for the participating health center. Mrs. Oros and Ms. Hosler were from Mosaic Group, which provided technical assistance for the project.

Financial Support

National Institute on Drug Abuse grant 1R01DA034258-04.

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Lounsbury, D.W., Mitchell, S.G., Dusek, K.A. et al. Application of System Dynamics to Inform a Model of Adolescent SBIRT Implementation in Primary Care Settings. J Behav Health Serv Res 47, 230–244 (2020). https://doi.org/10.1007/s11414-019-09650-y

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  • DOI: https://doi.org/10.1007/s11414-019-09650-y

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