Before You Begin

Decide on a screening method

The screening questions can be used at any time, alone or along with other tools, as part of a clinical interview. Some practices may prefer to incorporate the questions into written self-report questionnaires or computer screening that patients complete before seeing the clinician. You will need to protect patient privacy, of course, whether you ask the questions in person or by other means.

Think about opportunities and clinical indications for screening

• As part of an annual examination
• As part of an acute care visit
• In the emergency department or urgent care center
• When seeing patients who:
       - You have not seen in a while
       - are likely to drink, such as youth who smoke cigarettes
       - have conditions associated with increased risk for substance abuse, such as:
             - depression          - attention-deficit/hyperactivity disorder
             - anxiety                - conduct problems
       - have health problems that might be alcohol related, such as: 
             - accidents or injury              - changes in eating or sleeping patterns
             - sexually transmitted           - gastrointestinal disturbances
               infections or unintended    - chronic pain
               pregnancy
       - show substantial behavioral changes, such as:
             - increased oppositional       - change of friends
               behavior                              - a drop in grade point average
             - significant mood changes  - large number of unexcused school absences
             - loss of interest in activities

 

Set up your practice to simplify the process

• Educate office staff: Ensure that staff members understand the importance of universal alcohol screening for youth. Identify a lead "champion" to establish, monitor, and evaluate office screening procedures. 
• Decide how screening will be conducted: If a clinical assistant will screen instead of the physician, or if a print or computerized tool is used, work out record-keeping to facilitate followup in the exam room. Commit to screening at every possible visit.
• Set reminders: If available, use electronic medical records to cue for screening and followup.
• Prepare for confidential care: Establish procedures for providing confidential care. Become familiar with your State laws on a minor's ability to consent to substance use treatment (see page 25). 
• Prepare for referrals: Generate a list of, and build a rapport with, local adolescent alcohol treatment resources (see page 34); keep copies of the list in exam rooms.
  
• Stock materials: Keep copies of the Pocket Guide (provided) in exam rooms. Provide educational materials for parents (see page 38).