Implementation of screening, brief intervention, and referral to treatment (SBIRT) utilizing the CRAFFT+N among pediatric patients at an outpatient psychiatric practice

Background

Substance use among adolescents poses a significant public health challenge, with escalating rates over recent decades contributing to preventable morbidity and mortality. Despite its prevalence, only a fraction of affected individuals receive intervention, emphasizing the need for comprehensive healthcare strategies. The CRAFFT is a common tool used to evaluate substance use in youths, but limited studies have examined the innovative CRAFFT+N, which includes a nicotine screen. Thus, this study aimed to evaluate the feasibility and fidelity of pediatric SBIRT in an outpatient psychiatric setting through retrospective chart review, and secondary aims were to explore rates of pediatric substance use and associations with psychiatric variables and modality of visits, in addition to trends over time.

Methods

A retrospective chart review of electronic health record data was completed. Chi-squared analyses were used to compare which psychiatric diagnoses and psychotropic medications were associated with positive CRAFFT+N scores.

Results

A total of 455 patient encounters were reviewed, revealing concerning rates of substance and nicotine use, with approximately 20 % screening positive on the CRAFFT+N. Depressive disorders (p < 0.001), OCD (p = 0.012), and neurodevelopmental disorders (p = 0.015) were associated with positive CRAFFT scores. Positive nicotine scores were associated with bipolar disorders (p < 0.001), psychotic disorders (p = 0.001), and other psychiatric disorders (p = 0.039). Mood stabilizers were the only medication class associated with positive CRAFFT+N scores (both p < 0.001).

Conclusions

The new CRAFFT+N tool can be used to implement SBIRT into the workflow in an outpatient setting interested in assessing substance use in those aged 12–21 years.