Abstract
Background/Aims Adolescent risk behaviors are often highly clustered, so screening in Mental Health (MH) settings may be even more important for this population than for adults. We examined the role of screening in MH by describing findings from adolescent studies that examined co-occurring MH and substance use (SU) disorders, treatment utilization, and outcomes in an integrated health plan.
Methods We examined: 1) the prevalence of co-occurring disorders (CODs), and factors associated with treatment initiation among adolescents (N = 2,055) with CODs; 2) predictors of referrals by pediatricians to MH or SU treatment of adolescents with SU disorders (N = 400); 3) the co-occurrence of MH disorders, pathways to treatment and outcomes in a treatment sample of adolescents (N = 419); and 4) we used data from an RCT of adolescent Screening, Brief Intervention, and Referral to Treatment (SBIRT) (N = 1,070), to examine the prevalence of co-occurring problems, barriers to identification, referral, and treatment initiation.
Results Teens with CODs identified in MH were more likely than those identified in primary care to initiate treatment (P = .05). In the referral study, twice as many teens with SU disorders were referred to MH than SU treatment. In the SU treatment sample, we found: 1) high levels of CODs; 55% (230/419) had a MH diagnosis, compared to 2% (41/2077) of matched controls (P <.0001); and 2) low levels of identification and referral by psychiatric providers; fewer than half the sample seen in MH prior to intake received an SU diagnosis. In the SBIRT study, 30% (941/3177) of the teens screened positive for either SU, MH risk, or both. Many teens initially referred by providers for MH concerns exhibited SU risk upon further assessment.
Conclusions We found high rates of CODs among the adolescents in the health system, and that SU problems and CODs are insufficiently identified in MH and Primary Care settings. We discuss these missed opportunities for alcohol and drug problem identification, and implications and opportunities for SBIRT for adolescents in MH.
