Substance Use Assessment
CHILD AND TEEN CHECKUPS (C&TC) FACT SHEET FOR PRIMARY CARE PROVIDERS
C&TC Requirements
General
Anticipatory guidance about and assessment of
substance use is recommended for all C&TC
visits for youth 11 through 20 years of age.
Personnel
Physician, Nurse Practitioner, Physician
Assistant, Registered Nurse with adequate
training.
Documentation
Documentation should indicate the tool used,
results, and the plan to address the results.
Screening Procedure
Universal assessment for substance use is
recommended at every C&TC visit for 11
through 20 years of age.
The goal of universal assessment is to identify
each adolescent’s substance use experience,
ranging from abstinence to addiction, and
provide appropriate intervention for each
adolescent at every health care visit. For those
who do not report substance use, provide
positive reinforcement to prevent or delay
initiation of substance use. For patients who
report substance use, interventions ranging
from motivational interviewing to referral for
treatment could be used (American Academy of
Pediatrics, 2011).
Screening, Brief Intervention and
Referral to Treatment (SBIRT)
SBIRT is an algorithm for substance use
assessment and referral in primary care.
▪ Screening assesses the presence and
severity of substance use;
▪ Brief Intervention focuses on increasing
awareness and motivation toward behavior
change;
▪
Referral to Treatment provides those
identified as needing more extensive
services with access to care.
Refer to national SBIRT (www.samhsa.gov/sbirt)
resources for an assessment, referral and
treatment algorithm.
CRAFFT
The CRAFFT (www.ceasar-boston.org/CRAFFT/)
is an evidence-based tool for use with children
under the age of 21. It consists of a series of 6
questions to screen adolescents for high risk
alcohol use and other drug use disorders. The
CRAFFT is recommended by the AAP’s
Committee on Substance Abuse for use with
adolescents (Center for Adolescent Substance
Abuse Research, 2009).
Screening for substance use is most informative
when done without a parent or guardian
present. The patient and parent or guardian
should be informed of Minnesota’s Minor’s
Consent Law (MN Stat. § 144.343, 2015)
Follow-Up
SBIRT materials provide recommendations for
follow-up, depending on the individual’s report
of substance use. Children and adolescents with
substance use disorders should be managed
collaboratively with a child and adolescent
mental health or addiction specialist whenever
possible and scheduled for medical office visits
throughout the recovery process (American
Academy of Pediatrics, 2011).
Importance of Assessment
Substance use in adolescents is associated with
an increased risk of motor vehicles crashes,
emergency department visits, and suicide
(American Academy of Pediatrics, 2011;
Griswold, Aronoff, Kernan, & Kahn, 2008).
SUBSTANCE USE C&TC FACT SHEET
Substance use during adolescence is also
associated with alterations in brain
development, structure, and function and can
have potentially harmful implications for
subsequent academic, occupational, and social
functioning in adulthood. In addition, the
shifting social influences and peer group
affiliation may place adolescents at higher risk
for initiating and continuing substance use
(Squeglia, Jacobus, & Tapert, 2009).
In Minnesota,
▪ 34.7 percent of adolescents reported using
alcohol (Center for Behavioral Health
Statistics and Quality, 2015);
▪ 15.5 percent of adolescents reported binge
alcohol use (Substance Abuse and Mental
Health Services Administration, 2015);
▪ 7.8 percent of adolescents reported using
illicit drugs within the month prior to being
surveyed in 2014 (Substance Abuse and
Mental Health Services Administration,
2015).
Professional Recommendations
American Academy of Pediatrics (AAP)
▪ Screen all adolescent patients for substance
use with a formal, validated screening tool,
such as the CRAFFT, at every health
supervision visit and appropriate acute care
visits. Provide appropriate brief
interventions and if appropriate, refer for
treatment (American Academy of
Pediatrics, 2011).
U.S. Preventive Services Task Force (USPSTF)
▪ The current evidence is insufficient to
recommend for or against routine screening
for substance use or counseling about
substance use in adolescents (U.S.
Preventive Services Task Force, 2014).
Resources
American Academy of Pediatrics
▪ Guidelines for Health Supervision of Infants,
Children and Adolescents
(www.brightfutures.aap.org)
Minnesota Department of Health
▪ Child and Teen Checkups (C&TC)
(www.health.state.mn.us)
2
Minnesota Department of Human Services
▪ Minnesota Health Care Programs Provider
Manual C&TC Section
(www.dhs.state.mn.us)
References
American Academy of Pediatrics. (2011). Substance use
screening, brief intervention, and referral to treatment for
pediatricians. Pediatrics, 25(5), e1330-e1340.
Center for Adolescent Substance Abuse Research. (2009).
The CRAFFT screening tool. Retrieved from
http://www.ceasar-boston.org/clinicians/crafft.php
Center for Behavioral Health Statistics and Quality. (2015,
September 10). 2014 National Survey on Drug Use and
Health: Detailed Tables. Rockville, MD: Substance Abuse
and Mental Health Services Administration. Retrieved
from
http://www.samhsa.gov/data/sites/default/files/NSDUHDetTabs2014/NSDUH-DetTabs2014.pdf
Griswold, K. S., Aronoff, H., Kernan, J. B., & Kahn, L. S.
(2008). Adolescent substance use and abuse: recognition
and management. American Family Physician, 77(3), 331336.
MN Statute § 144.343. (2015). Minnesota's Minor's
Consent Law.
Squeglia, L. M., Jacobus, B. A., & Tapert, S. F. (2009). The
influence of substance use on adolescent brain
development. Clinical EEG Neuroscience, 40, 31-38.
Substance Abuse and Mental Health Services
Administration. (2015). Behavioral Health Barometer:
Minnesota, 2014. Rockville, MD: Substance Abuse and
Mental Health Services Administration. Retrieved from
http://store.samhsa.gov/shin/content/SMA154895/BHBarometer-MN.pdf
U.S. Preventive Services Task Force. (2014). Primary care
behavioral interventions to reduce illicit drug and
nonmedical pharmaceutical use in children and
adolescents: U.S. Preventive Services Task Force
Recommendations Statement. Annals of Internal Medicine,
160(9), 634-640.
For More Information
Minnesota Department of Health
Child and Teen Checkups Program
PO Box 64882,
St. Paul, MN 55164-0882
Phone 651-201-3760
[email protected]
www.health.state.mn.us
New: 04/2016
To obtain this information in a different format, call
651-201-3760.