Barriers to Screening Teens for Substance Abuse in Primary Care

The “Six T’s”: Barriers to Screening Teens for Substance Abuse in Primary Care (Van Hook et al., 2007)

Introduction

Primary care providers in pediatric, adolescent or family healthcare settings face significant barriers in the screening of substance abuse. From the most common to the least, they are insufficient time, lack of training to manage positive screen, need to triage competing medical problems, lack of treatment resources, tenacious parent and unfamiliarity with screening tools.

Summary

Though the barriers have different ranking, they are actually interrelated. The top rank barrier, insufficient time, staff don’t have enough time to deal with or refer positive screening result youth. It is attributed by the other barriers.  The providers mentioned that they don’t know how to manage a positive result in a limited time due to lake of training. As the treatment of substance abuse is not covered by medical insurance, there is difficult to hire more particular disciplines staff or to gain more efficient materials in limited resources and give a tight clinic schedule. It impairs physicians to have further investigation in the screening to give a suitable treatment or referral in a limited time. Staff are unfamiliar with screening tools make them waste too much time on screening because they are difficult to find an effective or suitable tools.

Some adolescents have sick visit due to some toxic effects of substance abuse. Physicians triage them as a medical problem and miss a chance to screen. The situation is improved when it is a well-care visit.

Tenacious parent who don’t leave the room to give a private and confidential discussions for their child. It is because they think they have an open relationship with child and will not hinder the discussion. Some is due to culture problem that it is inappropriate to leave their daughter alone with strangers.

Some staff find uncomfortable to discuss substance abuse with adolescents but it hasn’t been ranked due to they refuse to disclose more in front of their colleagues.

Suggestion

To give more time to medical staff, provide some computer or pencil/paper screening for adolescents to have a self-screening. Some basic test such as CAGE (Thomas, 2010) that involves low level techniques can allow office staff or teachers inside school to finish. 

To give more efficiency, focus screening resources in high risk groups such as 12th grade student to find out the target. (Matheson, McGrath, 2012) Adolescents who join party and disco frequently also have high potential in substance abuse. (Lee, 2001) We can spread some hair cut coupons for them as they really concern about their body image. During the hair cut, a screening can be done.