Child & Youth Mental Health Algorithm - GPSC

Substances use AssessmentAdolescence is the time during which most individuals first experience exposure to alcohol or othersubstances. Based on the scientific evidence, we know that the brain continues to develop throughoutadolescence and into young adulthood, and insults to it during this period may result in unwanted, negativeimpacts both short and long-term. Substance misuse and substance abuse then become important issues forthe health of young people.Screening for substances use should be part of general health assessments for adolescents. Although everyadolescent should be screened for substance use, there are some red flags that should trigger a morecomprehensive assessment. These are:Adolescents who present with substantial behavioral changesAdolescents who present to emergency medical services for traumaAdolescents who present medical problems such as accidents, injury, or gastrointestinal disturbanceAdolescents with significant decline in school grades and a high number of school absences.Screening for substance use/misuse/abuse provides an opportunity for psycho-education about the risks ofsubstance use (i.e., alcohol related car accidents are the number one cause of death in adolescents, psychosisrisk with marijuana smoking) and an approach to safe and moderate use of alcohol.For those youth whose substance use is harmful or putting them at risk for negative health or socialoutcomes, screening opens an opportunity for referral to specialized treatment programs that can providethem with the comprehensive evaluation and interventions that they require.A parsimonious approach to substance use screening in adolescent is the application of the CRAFFT screeningtool (CRAFFT = mnemonic acronym of first letters of key words in the six screening questions). The CRAFFT is avalid, reliable, and developmentally appropriate tool.When using the CRAFFT, begin by asking the adolescent to answer the following questions honestly andreassure him/her that the answers will be kept confidential within the reasonable limits to confidentialityaddressed.Another thing to have in mind when screening or substances in adolescents is that substance use can bemasking a mental disorder and it also can be a way of self-medication for a mental disordersC - Have you ever ridden in a CAR driven by someone (including yourself) who was "high" or hadbeen using alcohol or drugs?R - Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?A - Do you ever use alcohol/drugs while you are by yourself, ALONE?F - Do you ever FORGET things you did while using alcohol or drugs?F - Do your family or FRIENDS ever tell you that you should cut down on your drinking or druguse?T - Have you gotten into TROUBLE while you were using alcohol or drugs?