Northwell Begins Screening Children for Substance Abuse
Stepping up efforts to address the opioid crisis, Northwell Health expanded 'universal' drug screening to its children's hospital.
As part of efforts for early detection and diagnosis of opioid addiction, Northwell Health has expanded alcohol and substance abuse screening beyond adults to include patients aged 12 to 18 at Cohen Children's Medical Center.
Expansion of the addiction screening last week is part of the New Hyde Park, NY-based health system's commitment to help all patients address substance-abuse disorders, says Sandeep Kapoor, MD, director of the health system’s Screening, Brief Intervention and Referral Treatment program (SBIRT).
Northwell conducts SBIRT screening for every patient at all of the health system's emergency rooms and primary care practices, he says. "It's been a universal approach."
SBIRT is a key component of Northwell's response to the opioid addiction crisis because of the importance of early detection and diagnosis, says Joseph Conigliaro, MD, chief of general internal medicine at the health system. "The whole idea behind SBIRT is you can get at addiction early as opposed to getting it late, when the horse is out of the barn."
SBIRT, which Northwell launched in December 2013, features self-reported screening for alcohol and substance abuse with evidence-based tools. Northwell clinicians have been using two SBIRT evidence-based tools at primary care practices and emergency rooms for adults, and they are using one screening tool for children.
Self-reported screening features patients responding to screening-tool questions. For example, adults are screened for opioid and other illicit drug use with the Drug Abuse Screening Test, which qualifies and quantifies prescription and illicit drug use, then risk-stratifies patients.
At Northwell, Kapoor says brief interventions are the primary focus of SBIRT for patients detected with possible opioid addiction:
- The essential element of the brief intervention is a conversation that engages the patient about their opioid use. The conversation features four pillars of motivational interviewing: compassion, acceptance, partnership, and evocation.
- The interviewer seeks to build rapport and trust, then provides feedback on the screening with the patient's permission.
- The conversation serves as a starting point to help the patient gain insight and self-identify any consequences related to their opioid use.
- At the end of the conversation, the interviewer determines whether the patient is ready and willing to make a change, then helps the patient formulate a plan that could include referral to specialty care.
"It's a nonconfrontational conversation during a clinical visit—either in an emergency room or a primary care office," Kapoor says. “Even though it is busy, you pause and speak with the patient to better understand where they are at with their substance use."
The key to implementing SBIRT at Northwell primary care practices has been integrating the program into clinical workflows, Conigliaro says, noting that efforts with medical assistants and nurses helped screening for addiction become essentially another vital sign.