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White Paper: Costs and Implementation Effectiveness of Generalist Versus Specialist Models for Adolescent Screening and Brief Intervention in Primary Care

Feb 28, 2022 | White Papers and Studies

This white paper “Costs and Implementation Effectiveness of Generalist Versus Specialist Models for Adolescent Screening and Brief Intervention in Primary Care” was funded by National Institute on DrugAbuse (NIDA). It was authored by RTI International; Carolina Complete Health Network; Friends Research Institute; Mosaic Group; University of Maryland, Baltimore County; and Department of Psychology, University of Maryland, College Park. It was published in the Journal of Studies on Alcohol and Drugs in February 2022.


Objective: This study analyzed the marginal service and program costs, and conducted a cost-effectiveness analysis (CEA) of two models of implementation of adolescent substance screening, brief intervention, and referral to treatment (SBIRT).

Method: SBIRT was implemented at seven clinics in a multisite, cluster-randomized trial, through a Specialist model (behavioral health counselor–delivered brief intervention), and a Generalist model (primary care provider–delivered brief intervention). The CEA calculated marginal costs using an activity-based costing methodology for direct SBIRT services, and effectiveness was measured by the proportion of brief interventions delivered among patients who screened positive for alcohol, tobacco, or other drugs. Site-level program costs comprised start-up and maintenance (training and technical assistance). Costs were estimated in 2017 U.S. dollars.

Results: The marginal cost of SBIRT per patient with a positive screen for brief intervention was $6.72 in the Specialist model and $6.05 in the Generalist model. Implementation effectiveness was 7.2% (SE = 2.9%) in the Specialist model and 37.7% (SE = 5.6%) in the Generalist model. The program costs to provide SBIRT for 1 year per site were $13,548 for the Specialist site and $12,081 for the Generalist.

Conclusions: The Generalist model was more effective in implementing brief intervention and less expensive than the Specialist model. Results were robust to sensitivity analysis. Brief intervention delivered by primary care providers rather than by handoff to a behavioral health counselor may ensure greater penetration and a lower cost of these services in primary care settings. © 2022, Alcohol Research Documentation Inc.. All rights reserved.

RTI International is an independent, nonprofit research institute dedicated to improving the human condition. Our vision is to address the world’s most critical problems with science-based solutions in pursuit of a better future. Clients rely on us to answer questions that demand an objective and multidisciplinary approach—one that integrates expertise across the social and laboratory sciences, engineering, and international development.

Friends Research Institute promotes health and well-being through research, grants administration, education and treatment. For over 60 years, researchers at FRI have received federal, state, county, and private funding to conduct studies in the fields of substance abuse, health, HIV/AIDS, mental health, and criminal justice. Recent social research has focused on the development and assessment of innovative strategies in pharmacotherapy, psychosocial treatments, bio-behavioral HIV interventions, and prevention.

Carolina Complete Health Network is a new kind of Provider-Led network. We are a subsidiary of the North Carolina Medical Society and co-founders of a first-of-its-kind partnership with Centene Corporation, the North Carolina Community Health Center Association and other providers across North Carolina. We offer North Carolina practitioners a platform to improve clinical and administrative processes, as well as a unique voice in governance over medical policy. We combine the best of leading-edge national expertise with deep-rooted local knowledge of what works here in North Carolina.

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