Improving the delivery of adolescent clinical preventive services through skills-based training

Objective. To examine the efficacy of skills-based training workshops on pr imary care providers' screening and counseling practices with adolescents d uring routine outpatient well visits. Design. Sixty-three primary care providers in outpatient pediatric departme nts within a managed health care organization participated in two 4-hour wo rkshops on clinical preventive services for adolescents. The workshops focu sed on adolescent health, confidentiality, screening, and anticipatory guid ance/brief counseling for 5 risk behaviors including: helmet and seatbelt u se, tobacco use, alcohol use, and sexual behavior. A pre/post-test design w as used to assess clinicians' screening and counseling practices during the pretraining and posttraining periods. Independent adolescent reports of cl inicians' practices were obtained from 2 samples of 14- to 16-year-old adol escents immediately after their routine well visit in the outpatient clinic s. One sample of adolescents reported during a pretraining period and a sep arate sample reported during a period after the training. Results. Adolescent reports indicated that after the training workshops, th e average percentage of adolescents screened by their primary care provider s increased significantly for seatbelt use (from mean 38% to 56%), helmet u se (from mean 27% to 45%), tobacco use (from mean 64% to 76%), alcohol use (from mean 59% to 76%), and sexual behavior (from mean 61% to 75%). Additio nally, the average percentage of adolescents offered brief counseling by th eir clinicians increased significantly after training in the areas of seatb elt use (from mean 36% to 51%), helmet use (from mean 25% to 43%), and sexu al behavior (from mean 42% to 58%). Improvement after the training in brief counseling for tobacco use was marginally significant (from mean 60% to 69 %) and for alcohol use was not significant, although there was an increase. Clinicians also significantly increased their discussion of the limits of confidentiality with their adolescent patients after the training workshops (from mean 32% to 45%). Conclusions. This study offers strong support for the efficacy of skills-ba sed training for primary care providers as a method for increasing screenin g and counseling practices with adolescents. The present findings suggest t hat with appropriate skills-based training, practicing clinicians can imple ment several of the national guidelines that direct them to provide prevent ive services for multiple behaviors in a routine outpatient visit. Screenin g and counseling in these visits are important in the early identification, detection, and prevention of behaviors associated with the primary adolesc ent morbidities and mortalities. Thus, enhancing the delivery of clinical p reventive services is an important step in the prevention of untoward healt h outcomes for youth.