The Hippo


Jul 16, 2019








Before it’s too late
Medical providers trying to stop drug use in adolescence

By Ryan Lessard

 A program called Screening, Brief Intervention and Referral to Treatment, has met and exceeded its goal to screen thousands of adolescents for addiction risks during medical provider visits. The program began as a three-year, $2.5 million grant program that ended in June, but medical centers are continuing the screening practice and more clinics are adopting it.

How it works
While much of the debate over how to address the opioid epidemic seems to concern  incarceration versus treatment, nearly everyone agrees that prevention, especially among youth, is an important way for the state to battle addiction.
“Addiction is a children’s disease. Most people in recovery will tell you that their substance misuse began when they were adolescents,” said Tym Rourke, the director of substance use disorders grantmaking at the New Hampshire Charitable Foundation and the chair of the Governor’s Commission on Substance Use.
The program is a prevention effort designed to take place within an adolescent’s regular primary care settings.
Julie Everett Hill, the director of operations at White Mountain Community Health in Conway, said they adopted the screening practice for everyone age 12 and older annually.  
“Everybody who comes in for a wellness visit or a new patient appointment is screened. It’s like another vital sign for us,” Everett Hill said.
WMCH screens for depression at the same time. Every patient fills out a short questionnaire with a dry erase marker and a nurse inputs the answers into the patient’s electronic medical record.
The first question is “In the past year, how many times have you used alcohol, tobacco or marijuana?” According to Everett Hill, patients can answer “Never,” “Once or twice,” “Monthly,” or “Weekly or more.”
If they answer “Never,” there are no followup questions. But if their answers reflect possible risk factors, they are asked if they’ve tried prescription drugs that were not theirs or illegal drugs like cocaine or ecstasy or spice and so on.
A medical provider will review the answers before sitting down with the patient and, depending on the risk factors demonstrated in the questionnaire, act to either encourage good behavior or intervene on bad behavior.
If the patient has no risky behaviors, the provider engages in positive reinforcement techniques in an effort to make sure they stay on that drug-free path. If they demonstrate risky behaviors — maybe they experimented with pills or marijuana — then the provider uses what’s called “brief intervention,” techniques developed by Sharon Levy, a developmental medicine specialist at Boston Children’s Hospital.
“That is kind of a form of motivational interviewing, where they just have a conversation about how that risk of substance misuse can impact their life and try to identify if they’re ready to make any kind of modification in their behavior,” Everett Hill said.
And ultimately, if the provider thinks the patient needs a full clinical assessment or treatment, they will make the necessary referrals.
“It’s been going really well for us. I think it’s just become a part of our culture here,” Everett Hill said.
 Screening, Brief Intervention and Referral to Treatment was funded by a grant from the Conrad Hilton Foundation and supplemented and organized by the New Hampshire Charitable Foundation. The foundation modeled it on a pilot program it did with Goodwin Community Health in Somersworth, which was for all age groups. The goal of the initiative, when it launched three years ago, was to screen 10,000 young patients between the ages of 12 and 22. It was adopted by 23 medical facilities across the state, which received grants from the Foundation, according to Rourke. And they ended up screening more than 15,000 young patients.
“So we far exceeded the goals we set,” Rourke said.
Of that, about 15 percent, or roughly 2,000 patients, demonstrated risk factors and nearly 700 met the criteria for needing a referral to clinical assessment or treatment. 
He said studies have shown that young people are overwhelmingly honest with medical providers when asked about substance use. And Everett Hill has seen that play out on the ground.
“What we have found is that the kids are really wanting to talk with an adult. And this has given us the opportunity to open up the dialogue and ask the question,” Everett Hill said.
Moving forward
Rourke said that along with providing intervention services for those who are already heading down the road to addiction, providers also need to focus on keeping their non-risk patients on the straight and narrow. The ultimate goal is to make sure those roughly 13,000 patients who tested negative for risk factors continue testing negative in future visits.
Those medical centers that got started with the program through the grants are continuing to screen patients and intervene when necessary without the grant money in large part because they no longer need it, Rourke said. Screening is a reimbursable service, so the program now pays for itself.
Rourke said the Charitable Foundation also funded training and technical support for the initiative provided through the New Hampshire Center for Excellence, and it will continue to back that with money from its own fund to help other clinics that wish to adopt the screening program. 

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