Research, Teaching, and Clinical Contributions:
Narrative: After completing my fellowship in general pediatrics in 1992, I spent the first five years of my academic career concentrating on clinical and educational activities. During the last ten years, I have transitioned to spending most of my professional time on clinical research. Education: In 1993 I developed the Behavioral Pediatrics block rotation for pediatric residents at Children’s Hospital. In 1996, I was awarded grant funding from the Maternal and Child Health Bureau (MCHB) for the Collaborative Office Rounds project, aimed at providing problem-based education in psychosocial problems for community pediatricians. As PI, I have now seen this grant through four competing renewals over ten years. I then collaborated with Dr. Jean Emans from the Division of Adolescent/Young Adult Medicine to produce a standardized national curriculum for pediatric residents in child growth, development, behavior, and adolescent health. We enlisted fellows and junior faculty as case writers. I was the PI of two grants that supported this work, Co-PI of a third, and Dr. Emans and I served as national project Co-Directors. The completed curriculum was published in a three-volume book series, which MCHB distributed to every pediatric and family medicine residency training program in the U.S. I directed construction of the project’s website (www.pedicases.org), from which more than 24,000 educational sections (i.e., chapters) have been downloaded by more than 5,000 registered faculty so far. At Harvard Medical School, I oversaw development of the Addictions Theme and in 1997I became the Associate Director for Medical Education at the Division on Addictions. In 1999 I became Director of the HMS Addiction Medicine CME course, which has doubled in size under my leadership. I have given more than 100 invited presentations and 18 peer-review workshops at national meetings, many involving fellows and junior faculty members whom I mentor. I served for two years as the Director of Fellowship Training for the Division of General Pediatrics. I have received two mentorship awards and was selected as one of 11 national mentors for the Health Resources and Services Administration (HRSA)-supported faculty development project in substance abuse education.
Research: The primary goal of my research is to improve screening and intervention for adolescent substance abuse in general medical settings. My first studies in this area assessed the reliability of existing screening instruments among adolescent medical patients. I next conducted a pilot study aimed at developing a new screening device, the CRAFFT test, which was developmentally appropriate for adolescents, accurate, and practical for use in busy medical settings. In 1999 I was awarded an R01 grant from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) to conduct a validation study of the CRAFFT in a larger, general adolescent clinic population. This study has led to five publications (p. 18-19; #15-18, #20) and, as a result of this research, the CRAFFT has become the recommended standard of care screen for substance abuse among adolescent patients. CRAFFT has been reprinted in American Academy of Pediatrics (AAP) policy statements, the AAP Substance Abuse Guide, the Bright Futures Mental Health Guide, and in other national reports and guidebooks. We have distributed more than 20,000 CRAFFT test pocket cards in response to requests from individuals and health care organizations from across the U.S, Canada, and the U.K; and given permission for translations of the CRAFFT into French (Swiss Ministry of Health), Spanish, Finnish, Turkish, Czech, Russian, and Japanese. The next phase of my research is aimed at implementation of CRAFFT screening, and at development and testing of office-based interventions. I directed a pilot study, funded by the Robert Wood Johnson Foundation (RWJF), of a brief behavioral counseling approach for substance abuse that can be widely applied in primary care settings and a larger RWJF-funded multi-site trial of implementation of CRAFFT test screening. In 2004 I received two R01 grants from the National Institute on Drug Abuse (NIDA) to conduct (1) a randomized controlled trial of our new therapeutic approach and (2) an efficacy trial of screening and brief physician advice. In 2006 I received a 3rd R01 from NIDA through the competing supplement mechanism for an international collaboration with investigators in the Czech Republic in drug abuse research.
Leadership: In 1999 I founded the Center for Adolescent Substance Abuse Research (CeASAR) at Children’s Hospital Boston. CeASAR is a national research center that supports a full-time Director of Data Management (Sherritt), Director of Research Operations (Van Hook), Clinical Coordinator (Germak), Education Specialist (Silverman), and 1-4 Study Coordinators and Research Assistants. Part-time staff includes a PhD-level epidemiologist (Harris) and several junior faculty members (Wilson, Levy, O’Sullivan, Rojas). I currently serve as full-time Director of CeASAR. In 2002 I founded a primary care research network, the New England Partnership for Substance Abuse Research (NEPSAR), which is centered at CeASAR and includes the Adolescent Clinic at Tufts-New England Medical Center, the Pediatric Departments at Cambridge Hospital and Fallon Clinic (Worcester, MA), the Vermont Child Health Improvement Project, the Concord Family Practice (Concord, NH) and a number of school-based health centers. NEPSAR serves as the foundation for our controlled trial of screening and physician brief advice. I have also served as PI of several studies of college student drinking, and as Co-PI of several other funded studies with those I mentor. During the past seven years, I have received grant funding totalling more than $6 million and published more than 40 original scientific articles (18 first author, 21 last), 17 clinical reviews and book chapters (10 first, 7 last), and 10 chapters for the national Bright Futures Curriculum. I completed my third term on the AAP Committee on Substance Abuse and I also completed a term on the Executive Board of the Association for Medical Education and Research in Substance Abuse. I have also served on six federal work groups (National Institute on Drug Abuse (3), NIAAA, President’s Office of National Drug Control Policy), and two federal grant review panels (Agency for Healthcare Research and Quality, NIAAA). In recognition of my leadership potential in alcohol research, in 2004 I received a K07 Academic Career Award from NIAAA.