Talk to Me, Not Just My Parent: Teen and Caregiver Perspectives on Implementing Screening, Brief Intervention, and Referral to Treatment Equitably in Pediatric Inpatient Settings for Teens with Chronic Illness

Abstract

Highlights What are the main findings? Adolescents with chronic medical conditions (A-CMCs) and caregivers broadly supported inpatient SBIRT as important and appropriate, but its acceptability hinged on how it was delivered. Sociopolitical context such as stigma around “having a problem” versus normalized casual alcohol and drug (AOD) use, blurred lines between prescribed and nonmedical substances. Structural conditions such as limited behavioral health referral sources also shaped A-CMCs and caregivers’ willingness to disclose AOD use and their ability to benefit from SBIRT’s brief intervention and referral components. What are the implications of the main findings? Inpatient SBIRT for A-CMCs should adopt developmentally appropriate explanations of confidentiality and its limits, patient-centered workflows, and flexible timing/modality of SBIRT to build the relational safety needed for honest AOD use disclosure. Because referral alone may be insufficient given fragmented care and limited behavioral health access, inpatient hospitals should pair SBIRT screening with integrated, coordinated follow-up delivered in parallel with chronic illness care. Future implementation and co-design research should explicitly evaluate whether these adaptations advance equity or inadvertently widen gaps across racial, ethnic, disability, and socioeconomic groups. Abstract Background/Objectives: While screening, brief intervention, and referral to treatment (SBIRT) is a widely recommended evidence-based approach for early detection and intervention for alcohol and other drug (AOD) use, limited guidance exists for implementing SBIRT among hospitalized adolescents with chronic medical conditions (A-CMCs). This exploratory qualitative study examined A-CMC and caregiver perspectives on factors that may shape the acceptability, feasibility, and equitable implementation of a proposed inpatient SBIRT approach for A-CMCs. Methods: Two separate focus groups were conducted in an urban pediatric hospital in 2023 with A-CMCs aged 13–18 (n = 7), who had a history of hospitalization for their medical condition, and their caregivers (n = 6). Data were coded using thematic analysis guided by the Consolidated Framework for Implementation Research (CFIR) and the Health Equity Implementation Framework (HEIF), which captured implementation and equity-relevant determinants, respectively. Results: Although A-CMCs and caregivers recognized the importance of SBIRT within hospital settings, its acceptability hinged on the conditions of its delivery. The timing, relevance to current health needs, and modality of screening shaped an A-CMC’s willingness to disclose AOD use. Clinician communication style, including the use of a nonjudgmental tone and clear parameters for confidentiality, were also indicated as crucial for SBIRT delivery. Broadly, participants noted the significant impact that the sociopolitical context (e.g., stigma) and structural factors (e.g., financial burden) had on a family’s ability to benefit from SBIRT. Conclusions: In this exploratory qualitative study, participants identified confidentiality-forward, patient-centered workflows, and accessible follow-up supports as potentially important considerations for inpatient SBIRT among A-CMCs. These findings generate hypotheses for future co-design and implementation research across diverse pediatric inpatient settings.