The “Six T’s”: Barriers to Screening Teens for Substance Abuse in Primary Care
Received 18 September 2006; accepted 1 December 2006. published online 15 February 2007.
Abstract
Purpose
To identify barriers to adolescent substance abuse screening in primary care.
Methods
Focus groups were held at six primary care sites with a total of 38 providers. Providers brainstormed a list of barriers, collectively grouped similar barriers, and voted to produce a final ranked list. Two investigators qualitatively analyzed field notes and transcripts to triangulate findings, ranked the barriers across all sites by the number of groups identifying the barrier, then calculated a mean ranking (MR) for each.
Results
The most commonly identified barrier was insufficient time (MR 1.8). Lack of training in how to manage a positive screen was ranked second (MR 1.7), but was linked to the first. Providers reported they had enough time to administer a short screen, but insufficient time to manage a positive result during the well care visit. The need to triage competing problems (MR 3.0), lack of treatment resources (MR 3.3), tenacious parents who would not leave the room for a confidential discussion (MR 2.5), and unfamiliarity with screening tools (MR 3.0) were also noted by more than one group.
Conclusions
Insufficient time and lack of training in how to manage positive screens are the greatest barriers to screening adolescents for substance abuse. This suggests that some providers might differentially avoid screening youth who they suspect will screen positive, yet these patients would benefit most from early recognition. More research is needed on effective ways to manage positive substance abuse screens in primary care.
fPediatrics, Tufts New England Medical Center, Boston, Massachusetts
Address correspondence to: Ms. Shari Van Hook, Center for Adolescent Substance Abuse Research, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115.
ABSTRACT