The prevalence of mental health problems and substance use in adolescents has increased in recent years – and certainly we have seen skyrocketing increases in mental health problems during the pandemic. There are also some data that, in certain adolescent populations, the use of some substances (alcohol, cannabis) has also increased during the pandemic. ¹

Many pediatricians and primary care clinicians have not received much training in treating mental health problems and so may feel uncomfortable with these patients.

Screening, brief intervention and referral to treatment (SBIRT) is an approach that clinicians have used for adolescents with substance use issues. It includes screening using validated surveys, a brief motivational interviewing intervention, and a protocol for referring patients with more severe symptoms to behavioral treatment. Trials using this approach have demonstrated short-term positive impact, both on decreasing substance use and improving mental health problems.

Now, in a Pediatrics article being released this week, Parthasarathy et al report on 3-year outcomes in adolescents in the Kaiser-Permanente health system who screened positive for both substance use and recent mood symptoms (10.1542/peds.2020-009191). These adolescents had been randomized to receive one of the following:

• SBIRT by a pediatrician
• Referral to a behavioral clinician for SBIRT
• Usual care

For this analysis, adolescents randomized to SBIRT by a pediatrician or behavioral clinician were compared to those who received usual care. There were a total of 185 adolescents in the SBIRT group and 104 in the usual care group.

Adolescents who received SBIRT had:

• Lower odds of a diagnosis of depression at 1 year (OR 0.31; 95% CI 0.11, 0.87) and at 3 years (OR 0.51; CI 0.28, 0.94)
• Lower odds of a diagnosis of substance use at 3 years (OR 0.46; 95% CI 0.23, 0.92)
• Fewer visits to the emergency department (RR 0.65; 95% CI 0.44, 0.97)

These results are encouraging, but it should be noted that this study was conducted in a health system that provides behavioral health. Most pediatric primary care practices do not have embedded behavioral health providers. Additionally, this may be more difficult in practices that care for patients who are uninsured or underinsured for either physical or behavioral health and may not have access to such care. Many pediatricians and other primary care providers are receiving additional training in treating patients with mental health issues through CME offerings (one example is the REACH Institute’s Patient-Centered Mental Health in Primary Care (PPP) program), and this article may help to convince you of the benefit of doing so if you haven’t already.

Reference:

1. Dumas TM, Ellis W, Litt DM. What Does Adolescent Substance Use Look Like During the COVID-19 Pandemic? Examining Changes in Frequency, Social Contexts, and Pandemic-Related Predictors. J Adolesc Health, 2020 pp. 354-361.