Physician Committed

Physician Committed provides the medical community a toolkit with screening information, and algorithm for substance use and mental health, and protocol for next steps and follow up. Physicians, nurse practitioners and physician’s assistants use these tools during high school athletic physicals, acute care visits by teenagers, pediatric appointments and emergency room visits. Screening for substance use is just as critical for teens as checking their height and weight. Now, the medical community is prepared to respond and support.

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Why screen for underage drinking?

 

1 in 3 children start drinking by the end of 8th grade, and of them half report having been drunk.

It often goes undetected: Most adolescents visit a primary care practitioner every year or two (O’Conner et al. 1999), and many are willing to discuss alcohol use when they are assured of confidentiality. As a trusted health care provider, you are in a prime position to identify drinking-related risks and problems in your patients and to intervene. Our hope is that the brevity, ease of use, and predictive strength of this new tool will enable you to detect alcohol risks and prevent harm at the earliest possible stage.

It’s common: Alcohol is by far the drug of choice among youth. It’s often the first one tried, and it’s used by the most kids (Johnston et all., 2010). Over the course of adolescence, the proportion of kids who drank in the previous year rises tenfold, from 7% of 12 year olds to nearly 70% or 18 year olds.

It’s risky: In the short term, adolescent drinking too often results in unintentional injuries and death; suicidality; aggression and victimization; infections and pregnancies from unplanned, unprotected sex; and academic and social problems. In the long term, drinking in adolescence is associated with increased risk for alcohol dependence later in life (Hingson et al., 2006; Grant & Dawson, 1997).

It’s a marker for other unhealthy behaviors: When adolescents screen positive for one risky behavior-whether drinking, smoking tobacco, using illicit drugs, or having unprotected sex-it’s generally a good marker for the others. For many youth, drinking alcohol is the first risky behavior tried.

 

Why choose this tool?

It can detect risk early: This early detection tool aims to help you prevent alcohol-related problems in your patients before they start or address them at an early stage.

It’s empirically based: the screening questions are powerful predictors of current and future negative consequences of alcohol use.

It’s fast and versatile: The alcohol screen consists of just two questions that you can incorporate easily into patient interviews or pre-visit screening tools across the care spectrum, from annual exams to urgent care.

It’s the first tool to include friends’ drinking: The “friends” question will help you identify patients at earlier stages of alcohol involvement and target advice to include the important risk factor of friends’ drinking.

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Why screen for mental health issues?

 

29% of Butte County 7th graders, 32% of Butte County 9th graders, and 33% of Butte County 11th graders report feeling so sad and hopeless almost everyday that they stopped doing some usual activities.

 

The Importance of Mental Health in Primary Care: Primary care providers are often the first point of contact for families when it comes to the health and well-being of their child. They are in a key position to identify potential mental health concerns early and to communicate these concerns with families.

Open communication with families helps to reduce the pain and isolation often experienced by youth living with mental illness and their families.

Did you know…

13% of youth aged 8-15 live with mental illness. This figure jumps to 21% in youth aged 13-18.

1/2 of all lifetime cases of mental illness begins by age 14.

Despite the availability of effective interventions, there are average delays of 8-10 years from the onset of symptoms to intervention-critical developmental years in the life of a child.

Fewer than 1/2 of children with a diagnosable mental illness receive mental health services in a given year.

Encourage Open Communication: Make questions about a child’s mental health part of routine practice to facilitate open communication with families. Families suggest asking these 5 questions:

  1. Do you have any concerns about you child’s mental health?
  2. How is your child behaving in school, at home, in the community and with peers?
  3. Have you noticed any changes in your child’s moods?
  4. Is your child sleeping and eating well?
  5. Is there a family history of mental illness?

Families suggest making these 5 helpful comments when a child has a mental illness:

  1. There is hope. Use hopeful, encouraging and positive statements to talk about mental health.
  2. You are not alone. Share how common mental illness is and information on local support groups and resources so families feel less isolated and alone.
  3. It is not your fault. Families appreciate reassurance that they are not to blame for their child’s mental illness.
  4. I understand. Show empathy, compassion, and understanding. Consider sharing personal stories about mental illness.
  5. You and your child have many strengths. Set a positive tone for a conversation about mental health by talking about how these can help them meet challenges.

Take action to support families:

  1. Ask questions to begin an interactive discussion about a child’s mental health.
  2. Screen within the primary care office to identify mental health issues early.
  3. Evaluate for other physical conditions that can mimic mental illness and rule these out before making a diagnosis.
  4. Discuss options for mental health services and supports, including psychosocial interventions, parent skills, training, and medications.
  5. Suggest support groups, family education programs, and other local resources to learn more.
  6. Refer families to mental health providers for further evaluation and services.
  7. Follow up with referrals to ensure help was received. Make appointments for families, if necessary.
  8. Encourage families to seek treatment and to give it time to work.
  9. Provide treatment when mental health providers are not available.
  10. Check in with families to see if treatment is working. If not, re-evaluate treatment options and providers.

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Physical Symptoms and Signs Suggestive of Mental Health and Substance Abuse Concerns

Sleep Problems

  • Excessive sleep
  • Significant change in sleep patterns
  • Difficulty falling or staying asleep
  • Nightmares

Chronic, Recurrent, or Unexplained Physical Symptoms

  • Abdominal pain
  • Joint pain
  • Headache
  • Fatigue or low energy
  • Loss of appetite
  • Epigastric pain or gastritis (alcohol use)
  • Chest pain or difficulty breathing (panic/anxiety attacks)
  • Oligomenorrhea, especially in women of low weight (anorexia, teen pregnancy)
  • Irregular menses (anorexia, bulimia)

Neurologic Symptoms

  • Legs weak
  • Limb paralysis (conversion reaction)
  • Pseudoseizures
  • Non-physiologic neurologic symptoms
  • Difficulty concentrating, inattention in school
  • Irritability, restlessness

Physical Findings

  • Excess weight gain or loss
  • Parotid gland enlargement, dental enamel erosion, calluses or erosions on knuckles (purging)
  • Cigarette burns, multiple linear cuts or patterns (self-harm, maltreatment)
  • Metabolic abnormalities such as hypochloremic metabolic alkalosis, low potassium, or elevated amylase (purging)
  • Recurrent injuries (maltreatment, self-harm)
  • Isolated systolic hypertension (alcohol use)
  • Chronic nasal congestion (cocaine use)
  • Chronic red eyes (marijuana use)

Other

  • Worsening symptoms of previously well-managed chronic illness
  • School absences

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In order to asses a young person’s exposure to alcohol and mental health disorders, we must ask the 5 questions below:

Alcohol:

  1. Do you have any friends who drink?
  2. Have you ever had more than a few sips of alcohol?

Mental Health:

  1. In general, how do you think things have been going for you lately?
  2. What are the things that are more stressful for you?
  3. what changes have you noticed in your sleep lately?

To see how to asses the answers to the above questions, click here to view the Physician Committed Toolkit.

For more information regarding Physician Committed, please contact Jennifer Skinner at jskinner@buttecounty.net.

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