Substance use: an adolescent health concern

Abstract

Purpose: This Doctor of Nursing Practice (DNP) project’s purpose was to implement the Screening, Brief Intervention, Referral to Treatment (SBIRT) model with the Car, Relax, Alone, Forget, Family/Friends, Trouble (CRAFFT) screening tool to increase the identification of adolescents at risk for substance use behaviors and provide resources on referrals to treatment during non-acute emergency department (ED) visits. Background and Review of Literature: Substance abuse is the number one health concern in adolescents reported in the national representative household survey. Many adolescents are not screened for substance use in the ED, primary care, or school setting since valid and reliable screening tools to assess substance use in adolescents are not a standard component of clinical assessments by healthcare providers. Effective screening for risky behaviors in adolescence and referral protocols that promote early identification and enrollment with services is needed. Systematic literature review of risky behavior screening in adolescence in PubMed, Cochrane Database of Systematic Reviews, Google Scholar, and Ovid databases produced 1,158 peer-reviewed articles published since 2013. Of these, 12 met inclusion criteria of English language and SBIRT model with CRAFFT screening tool. Methods: The SBIRT model with the CRAFFT screening tool was implemented in the Wilmington ED during the Fall of 2019. Nursing staff performed screening and provided resources for referrals to treatment to all clinically stable adolescents between the ages of 14 to 21 years. Results: Over eight weeks, ED staff screened 54 adolescents for risk-taking behaviors, of which 25 had a CRAFFT score greater than zero (46%). Of those screened, 54% received positive feedback, 22% received a brief intervention, and 24% received a referral to treatment based on the CRAFFT score. Conclusions: Nursing staff in the Wilmington ED successfully deployed the SBIRT model with the CRAFFT screening questionnaire during an eight-week trial. Adolescents with a positive screen for risk-taking behaviors were able to receive the interventions and resources to referral for treatment provided. This demonstrated that implementation of the SBIRT model and the CRAFFT screening questionnaire identified at-risk adolescents and provided needed early intervention using the SBIRT model. ☐ Keywords: “substance use”, “adolescents”, “screening”, “SBIRT model”, “CRAFFT screening tool"