The goal of screening is to assess an adolescent’s substance use in the past year.
Patterns of substance use generally fall under the following categories:
- No use
- Sporadic use
- Regular use
- Regular use with repeated negative consequences (disorder)
Screening for substance use informs and guides the response of the provider, and should be:
- Universal. The prevalence of substance use among adolescents coupled with long term negative consequences justifies screening every student who visits the SBHC, regardless of medical complaint, reason for visit, or suspicion of use by the clinician. An additional benefit of universal, routine screening is that it can help normalize the screening process and reduce stigma among adolescents.
- Standardized. SBHCs should use a tool validated for adolescents by peer-review to screen for substance use, as opposed to using un-tested questions or improvised conversations.
- Routine. Rates and types of substance use may change throughout adolescence, justifying screening for substance use on a regular basis. As such, SBHCs should develop and implement a protocol for periodicity of screening for substance use.
- Confidential. In addition to protecting confidentiality of patient information as required by state and federal law, SBHC staff should be mindful of additional substance use-specific confidentiality concerns. For example, providers should be familiar with their state’s laws about the limits of confidentiality with respect to discussions about drug/alcohol use.
We encourage SBHCs to use the most recent version of a validated screening tool.
The following video explains the Screening component of SBIRT.
Given the high co-occurrence of substance use, trauma, and mental health challenges, screening for depression and other co-occurring conditions is an essential component to adolescent substance use screening. Providers must be knowledgeable about available comprehensive psychosocial screens, as well as equipped to identify and treat (or refer to treatment for) co-occurring conditions, diagnoses, and other issues needing support.
SBHCs may choose to use a validated tool for assessing depression, anxiety, and suicide risk.
The following video addresses suicide assessment and its relationship to SBIRT.
- School-Based Health SBIRT Quick Guide Substance Use: Screening
- The following validated screening tools (listed here with corresponding research indicating their validity) are feasible for use in school health settings:
- CRAFFT: Shenoi RP, Linakis JG, Bromberg JR, et al; Pediatric Emergency Care Applied Research Network. Predictive Validity of the CRAFFT for Substance Use Disorder. Pediatrics. 2019; 144(2): 2018 – 3415.
- S2BI: Levy SJ, Williams JF; AAP Committee on Substance Use and Prevention. Substance Use Screening, Brief Intervention, and Referral to Treatment. Pediatrics. 2016; 138(1): 2016-1211.
- BSTAD: Kelly SM, Gryczynski J, Mitchell SG, et al. Validity of brief screening instrument for adolescent tobacco, alcohol, and drug use. Pediatrics. 2014; 133(5):819-26.
- AUDIT: Cortés-Tomás MT, Giménez-Costa JA, Motos-Sellés P, Sancerni-Beitia MD. Different versions of the Alcohol Use Disorders Identification Test (AUDIT) as screening instruments for underage binge drinking. Drug Alcohol Depend. 2016;158:52-59. doi:10.1016/j.drugalcdep.2015.10.033
- LEVEL 2—Substance Use—Child Age 11–17 (Adapted from the NIDA-Modified ASSIST)
- PHQ: Kroenke K, Spitzer RL, Williams JB. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med. 2001; 16(9): 606-613.
- GAD-7: Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006; 166(10): 1092-1097.
- ASQ (Ask Suicide Screening Questions) Toolkit
- C-SSRS: The Columbia Suicide Severity Rating Scale (C-SSRS) Supporting Evidence
- Some school-based health centers might choose to use comprehensive screening tools, such as those listed below (may have cost associated).
- SBIRT Screening Tools and Examples
- Adolescent Substance Use Screening: A Review of Brief Validated Tools