A Comparison of Screening Practices for Adolescents in Primary Care After Implementation of Screening, Brief Intervention, and Referral to Treatment

J Adolesc Health. 2019 Jul;65(1):46-50. doi: 10.1016/j.jadohealth.2018.12.005. Epub 2019 Mar 6.


Purpose: The American Academy of Pediatrics recommends screening adolescents for substance use at all well-child and appropriate acute-care visits. However, many pediatric practices aim for such screenings annually at well-child visits.

Methods: As part of a larger study, 7 urban Federally Qualified Health Center clinics implemented universal screening for risky alcohol and drug use using the Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) screening tool. The present study compared uptake of screening and screening results at well-child versus acute-care visits.

Results: Over a period of 13 months for which encounter-level electronic medical records data were available, there were 6,346 clinic visits by 3,475 unique patients aged 12-17 years, at which 76.6% (n = 4,865) of visits had a screening for problematic substance use conducted. Rates of screening were 95.1% (2,750/2,891 involving 2,629 unique adolescents) for well-child visits and 61.2% (2,115/3,455 involving 1,535 unique adolescents) for acute-care visits. Rates of positive screening results were 9.0% (248/2,750 involving 245 unique adolescents) for well-child visits and 7.8% (164/2,115 involving 126 unique adolescents) for acute-care visits. Of the 469 unique adolescents screened only during an acute-care visit during that same period, 40 unique adolescents had positive screening results for a positive screening rate of 8.5%.

Conclusions: Nearly 10% of adolescent patients screened only at acute-care visits would not have been screened if screening was implemented solely at well-child visits, and 40 adolescents reporting substance use would have been missed. The findings highlight the benefits of screening adolescents at every primary care visit to better detect and intervene in adolescents' substance use.

Trial registration: ClinicalTrials.gov NCT01829308.

Keywords: Adolescent health; Prevention; SBIRT; Screening; Substance use.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Child
  • Delivery of Health Care
  • Electronic Health Records / statistics & numerical data
  • Female
  • Humans
  • Male
  • Mass Screening / statistics & numerical data*
  • Primary Health Care / statistics & numerical data*
  • Referral and Consultation*
  • Research
  • Substance-Related Disorders / diagnosis*

Associated data

  • ClinicalTrials.gov/NCT01829308