Faculty/Presenter Disclosure

• Faculty: Dr. Deena M. Hamza

• Relationships with commercial interests:• Not applicable

Dr. Deena M HamzaFaculty of Medicine & Dentistry, Department of Family Medicine; School of Public Health

February 12th, 2018

Early Identification and Intervention for Youth Substance Misuse + Mental Health

1. Introduction to a comprehensive intervention approach for

substance misuse and related mental health conditions

2. Example in Action: Comprehensive intervention approach

in Alberta: • Findings from the EMPATHY Program

3. Application to Primary Care

4. Future Directions

SCREENING

BRIEF INTERVENTION

REFERRAL TO TREATMENT

Traditional Approach to Substance Use Treatment:

Universal

tactics for those who have never initiated

use

Acute or specialized

for those with a substance use disorder

Overlooked

group: moderate – risky substance use

(Empowering a Multimodal Pathwaytoward Healthy Youth)

Funded by from January 2014 – June 2015

Entire School District: Grades 6 – 12

Primary outcomes of interest: suicidality and depression

Secondary outcomes of interest: substance misuse, self-esteem, and quality of life

Screening

• Patient Health Questionnaire (PHQ-9): • Depression; Suicidality

• Hospital Anxiety and Depression Scale (HADS-A):• Anxiety

• CRAFFT Substance Use Screening Tool: • Substance Use Disorder

Electronic TabletScreening Tool App

BriefIntervention

Image courtesy of: Hazelden Betty Ford Foundation

Motivational Interviewing • Guiding individuals

“step-wise” through recovery process

Motivational Enhancement Therapy• Counselling to identify

and resolve ambivalence about change

Brief *online*Intervention

Image courtesy of: http://pathwaysreallife.com/cognitive-behavioral-therapy/

Screening

BriefIntervention

Referral to Treatment

Addiction & Mental Health

443

198 208

151

291*

99** 11771**

154

70 71 53

99*

35* 36* 34*

0

50

100

150

200

250

300

350

400

450

500

SUD SUD+DEPRESSION SUD+ANXIETY SUD+DEP+ANX

NU

MBE

R O

F ST

UDE

NTS

Change in number of students at risk of substance use disorder and concurrent depression and/or anxiety

(*p<0.001; **p<0.01)

BASELINE_CS ASSESSMENT #4_CS BASELINE_LT ASSESSMENT #4_LT

Cross-Sectional Results

Substance Misuse (CRAFFT)3 to 3

Depression (PHQ-9):10 to 8 (p<0.001)

Anxiety (HADS-A):10 to 9 (p<0.05)

Longitudinal Results

Substance Misuse (CRAFFT)3 to 2 (p<0.001)

Depression (PHQ-9):10 to 7 (p<0.001)

Anxiety (HADS-A):10 to 8 (p<0.001)

• Insufficient time• Lack of training on how to manage a positive screen

• Unfamiliarity with screening tools • Opportunistic identification overburdening existing

services

Van Hook, S., Harris, S. K., Brooks, T., Carey, P., Kossack, R., Kulig, J., & Knight, J. R. (2007). The “Six T’s”: barriers to screening teens for substance abuse in primary care. Journal of Adolescent Health, 40(5), 456-461.

An argument in favor of implementing SBIRT in Primary Care

• Stand-alone computerized SBIRT pathway – no guess work

• Administered during wait time • Use of existing brief online interventions in a stepped

care approach

creening rief ntervention

eferral to

reatment

Image: Gov.uk Open Government License v 3.0

Grades 6 – 12

at risk of mental illness

students

• Research program: Streamlined Pathway to Addictions and Mental Health Treatment• Reexamine barriers to implementing SBIRT• Develop training tool for practicing family physicians• Develop an educational tool for family medicine

residents• Create a computerized pathway with customizable

brief online intervention guided by screening results

• Dr. Peter Silverstone • Dr. Andy Greenshaw• Dr. Shelley Ross• Dr. Lee Green

Image courtesy of: Vermont Public Radio