Mapping Quality AdolescentCentered Care Using Substance Abuse CRAFFT

Mapping Quality Adolescent-Centered Care: Using Substance Abuse CRAFFT Screening Tool & Strength-Based Approaches Peggy Carey MD & Amy Danielson and Lise Vance, Research Assistants University of Vermont College of Medicine Department of Family Medicine, Boston Children’s Hospital, Fletcher Allen Healthcare, Milton Family Practice Setting Objectives • Determine Prevalence of CRAFFT+ screens (Picture 1) among teens presenting for routine care ages 12 -18 yrs in variety of NE settings • Rational of screening at preventive, sick and other visits and for screening new vs. old patients • Introduce Strength Screening • • Results Types of Visits Prevalence of CRAFFT+ Screens Strength-based “Protective factors” Higher number of CRAFFT+ screens at new patient visits, acute and other “non-preventive” (Well Child check-ups. • Physician Assessments • Prevalence rates reported in JAMA’s Archives of Pediatrics & Adolescent Medicine “Prevalence of Positive Substance Abuse Screen Results Among Adolescent Primary Care Patients”, November, 2007. • Graph below Protective Factors Screening Sites Milton, Vermont has just under 10, 000 population and is a rural working class town with VT’s largest trailer park and suburban homes. Milton Family Practice provides obstetrical through geriatric care. The 5 other sites include Pediatric group model HMO, urban hospital adolescent clinics, and 3 school-based clinics in Boston area. Discussion and Future Work Screening for Substance Abuse using validated CRAFFT tool provides awareness for adolescents of potential hazards associated with substance use and driving. For example, asking teens about drinking in the context of Substance Use or even Non -personal use alerts teens to the hazards of this potentially lethal combination. Motorized vehicles and substance use/abuse do not mix. Very High Frequency Rates of CRAFFT+ Substance Abuse Screening tests (Range: One out of almost 3 -7 teens walking into primary care offices for routine care) ought demand greater attention to universal screening of Substance Abuse in teens, particularly, given dire outcomes of substance use and driving. Therefore it is not only important to include routine screening at preventive visits, but need to liberalize recommendations to include new, sick (acute) and other visits. A Third CRAFFT Screening Study has begun to evaluate Brief Intervention/ Motivational Interviewing to focus on the higher risk category of CRAFFT+ teens. This intervention may require additional time from the adolescent’s physician/clinician and/or collaborative behavioral consultant. • Other possibilities in a public health/community health realm could involve increased use of the Promotora Model. Strengthbased literature assigns high regard for the involvement of a parent, teacher or other trusted adult for laying brickwork for a “Protective” health home Methods Background • National Institute on Drug Abuse (NIDA): Addiction to alcohol, other drugs, is a chronic disease with genetic, environmental and behavioral factors • Addiction can begin in adolescence & early onset of drug use highly predicts addictive disorder later in life • By HS Sr year, 60% of teens have begun to drink; 40% use prescription & illicit drugs • Substance use associated with lead causes of death for US teens: unintentional injuries (MVA, drowning), homicides and suicides • AMA, AAFP&AAP recommend all teens receive screening at preventive visit • Adherence to universal screening low • Strength-based literature assigns high regard for involvement of a parent, teacher or other trusted adult to lay brickwork for a “Protective” health home • Strength-Screening & Capacity Building welcome teens at their greatest point of confidence: Where Change Occurs • Prospective observational study consisting primarily of a survey • Conducted in NEPSAR sites including urban, suburban, rural areas and diverse racial, ethnic and socio-economic levels • 12 -18 yr olds between March 1, 2004 - April 31, 2005, 14 month recruitment period • 49 individuals excluded because of medical / emotional instability on arrival day • 2133 patients accept participation (93%) • Survey tool includes 8 -item demographic questionnaire, 6 -item CRAFFT screen & 3 -item questionnaire on preference for type & methods of CRAFFT screen (computer vs paper, …) • Physician/Clinician training sessions • Screening for Risk & Protective Factors (started 2005) • Quality Improvement Run Charts for Screening of Four Protective Factors • Physician/Clinician assess follow-up concerns Prevalence of a CRAFFT Screening Test Score of 2 or Higher by Demographic Characteristics in 2133 Patientsa