Training Healthcare Providers in Adolescent Alcohol and Substance Use Screening through Project ECHO in Rural Pennsylvania: A Brief Case Report

Adolescent alcohol and substance use remain major public health concerns in Pennsylvania, particularly in medically underserved areas, yet adoption of Screening, Brief Intervention, and Referral to Treatment (SBIRT) for early identification and prevention among healthcare providers remains inconsistent. This study assessed whether participation in a Project ECHO (Extension for Community Healthcare Outcomes) SBIRT series improved providers’ knowledge, confidence, and early implementation of SBIRT for alcohol and substance use screening. We conducted a descriptive evaluation of the Project ECHO SBIRT training using baseline, post-series, and monthly follow-up provider surveys. Baseline, post-series, and monthly follow-up surveys assessed SBIRT knowledge, screening intent, and real-world implementation. Descriptive statistics summarized provider characteristics, screening practices, and SBIRT utilization across baseline and follow-up surveys. Pre-post knowledge changes were assessed at endline using McNemar’s, Bowker’s, and Wilcoxon signed-rank tests, with significance set at p < 0.1 due to attrition and high baseline knowledge. A total of 227 providers from 52 Pennsylvania counties participated. At baseline, fewer than half reported routine alcohol or substance use screening during adolescent well-child visits. Post-training, providers demonstrated significant improvements in knowledge of core SBIRT components, including tool feasibility, sensitivity, and applicability to both alcohol and substance use. Monthly follow-up data indicated early real-world implementation, with over half of respondents reporting first-time SBIRT use and increased adolescent screening within 30 days. Persistent barriers to implementing SBIRT included time constraints and patient readiness. Project ECHO is a feasible and scalable public health training model that improves provider knowledge and supports early SBIRT implementation for adolescent substance use, particularly in medically underserved settings.