Screening, Brief Intervention, and Referral to Treatment to Address Adolescent Substance Use

Why is this Program Important?

Adolescence is a time of rapid change and maturation. It is also a time of experimentation. Some of these experiments are harmless. Others, such as using alcohol or other drugs, can have long-lasting harmful consequences. Not only does adolescent substance use have its own risk, it is also associated with other risky behaviors such as unintentional injuries and death, suicidal behavior, motor vehicle crashes, intimate partner violence, and academic and social problems (Brown et al., 2008; Cole et al., 2011; Weitzman and Nelson, 2004).

Pediatric care providers can help adolescents avoid and reduce substance use. Most adolescents visit a physician every year (Hagan et al., 2008). Adolescents consider physicians to be an authoritative source of information about alcohol and other drugs and are willing to discuss the issue of substance use with them, if the adolescents feel that the conversation will remain confidential (Ford et al., 1997). For adolescents who are not using substances, these discussions provide an opportunity to encour-age healthy choices. Studies show that this reinforcement works (Brown and Wissow, 2009). For adolescents who are using sub-stances, conversations about substance use show that pediatric care providers are sincerely concerned about the health of their patients, and research suggests that youth have positive impres-sions of providers who are willing to discuss sensitive issues like substance use (Brown and Wissow, 2009).

Who Can Benefit?

This course is targeted to the primary care clinicians interested in addressing adolescent substance use. It requires a team-based approach within the practice to implement.

Program Details

This course utilizes online technology and quality improvement strategies to help practices seeing adolescents to:

• Recognize the importance of screening for substance use as part of routine health care and as needs arise to identify and treat individuals whose patterns of substance use put their health at risk.
• Identify and equip staff members to use validated screening tool(s) for adolescent substance use detection.
• Recognize the goal of a brief intervention to motivate patients to continue abstaining, or to stop/reduce using substances due to the negative health and safety effects of use.
• Provide general and substance-specific educational materials suitable for the age, health literacy, language, and culture of the practice's patient/family population.
• Lead discussions to help patients who are using substances establish feasible, short-term behavior change goals.
• Recognize that patients with reported substance use who are unable to meet behavior change goals, have reported mod-erate or severe use, and/or significant psychiatric or medical comorbidities should ideally receive more intensive, special-ized evaluation and care.
• Identify specialized adolescent substance use evaluation and/or treatment resources within the community and beyond to which you can refer patients needing more specialized care.
• Realize the pediatric medical home's ongoing responsibility to support the recovery process and to help sustain treatment gains and prevent relapse. Schedule follow-up appointments with patients as indicated.

The quality improvement approach within this course is based on the Model for Improvement and consists of testing strategies and tools and using measurement to assess progress in practice improvements. Practices test an idea by using a Plan, Do, Study, Act (PDSA) cycle. This cycle consists of conducting rapid tests of change on a small scale, learning from the results, and applying the learning to the next test cycle to work out the imperfections before full implementation.

Knowledge is essential but not sufficient to produce behavior change. Quality improvement activities have been shown to be an effective tool to change clinical care.

How is the Program Implemented?

This is an online program, but activities addressing practice level change would require in-person discussion among practice team members.

Delivering Value and Impact

This course is consistent with the current AAP clinical report Substance Use Screening, Brief Intervention, and Referral to Treatment. SBIRT is an evidence-based approach that addresses all substances – from alcohol and tobacco to misuse of prescrip-tion medications including opioids. Additionally, this course allows the flexibility for pediatric practices to determine which aspects of SBIRT they want to implement and allows for ways to measure those changes to see if they made an impact.