797 - Screening for Substance Use in the Pediatric ED: Lowering Thresholds to Increase Reach

Poster Board #: 797
Publication #: EP-129.797

Background: Substance use is common among adolescents; 80% of 12^th graders report alcohol use and 21% report marijuana use. Adolescent Screening, Brief Intervention, and Referral to Treatment (SBIRT) uses the CRAFFT Screening tool to risk-stratify adolescent substance use. While the CRAFFT was validated for identifying a substance use disorder (SUD) in adolescent patients in an ambulatory setting, a study of CRAFFT in an emergency department (ED) setting found that a lower score was indicative of problematic use over a three-year period.


Objective: Adapt the CRAFFT tool to identify and address any substance use among adolescents in the ED, not just high-risk substance use


Design/Methods: A team-based adolescent SBIRT program was implemented in a pediatric ED in Jan. 2018. The CRAFFT tool was programmed into the electronic health record (EHR) for patients ages 12-17, and was completed by the patient’s primary nurse, physician, and/or advanced clinical provider. ED Team Members (physicians and social workers) meet with patients who screen positive to provide brief interventions and referrals to treatment as indicated. A “Positive” CRAFFT is a score of 2+, which correlates to two “Yes” responses on Part B. A “Positive CRAFFT” has a sensitivity of 76% and specificity of 94% for identifying any substance problem according to DSM-IV criteria. For clinical workflow, a “Positive” is any “Yes” response in Part A, as opposed to standard practice of two “Yes” responses in Part B.


Results: From Jan. 2018 to Oct. 2019, 8,694 of 24,057 (36.1%) patients ages 12-17 were screened using the CRAFFT. 1,260 (14.4%) of patients screened responded “Yes” to at least one question in Part A. Of those, Part B questions were asked of 1,066 (84.6%) patients and 334 (26.5%) had at least two “Yes” responses. The substance use most frequently reported was marijuana (9% in 2018, 11% in 2019) followed by alcohol (8% in 2018, 7% in 2019). Based on the clinical protocol and patient identification, 377 brief interventions and 29 referrals to treatment were provided.

Conclusion(s): Using a lower threshold for a positive screen identified four times (1,260 vs. 334) as many patients with substance use for a further conversation. One limitation is the CRAFFT programmed into the EHR does not specifically ask about vaping and may not have captured adolescent patients vaping THC or other substances. Next steps include updating to CRAFFT version 2.1+N to better identify vaping, and to expand the program to adolescents in additional EDs and pediatric ambulatory practices.

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Authors/Institutions: Monica Shekher-Kapoor, Cohen Children's Medical Center, Queens, New York, United States; Laura Harrison, Northwell Health, New Hyde Park, New York, United States; Nicole Ciccione, Cohen Children's Medical Center, Queens, New York, United States; Jency Philipose, Cohen Children's Medical Center, Queens, New York, United States; Linda DeMasi, Northwell Health, New Hyde Park, New York, United States; Joshua Rocker, Cohen Children's Medical Center, Queens, New York, United States; Kate O'Neill, Northwell Health, New Hyde Park, New York, United States; Nancy Kwon, Long Island Jewish Medical Center, New Hyde Park, New York, United States; Jonathan Morgenstern, Northwell Health, New Hyde Park, New York, United States; John D'Angelo, Northwell Health, New Hyde Park, New York, United States; Sandeep Kapoor, Northwell Health, New Hyde Park, New York, United States