Substance misuse remains a significant public health challenge. Without intervention, early initiation of substance misuse during adolescence can lead to long-term negative health outcomes, including the development of a substance use disorder (SUD), criminal behavior, academic problems, and mental health issues. Thus, early prevention efforts, particularly those that involve early risk identification and referral, play a critical role in mitigating these risks in youth.

One such approach is the Screening and Prevention Model. Screening combined with a tailored family-based prevention program reduces the likelihood of early initiation of substance misuse. A study examining this model in 10- to 13-year-olds found that youths identified as at-risk through screening during well-child primary care visits and who were referred to a family prevention program had reduced substance use initiation, amount of use, risk factors, and anxiety at 12-months follow-up compared to usual care. Thus, the Screening and Prevention Model is a promising method for preventing substance misuse and poor mental health in youth.

Key Features of Screening and Prevention Model

• Leverages natural contact points. Pediatric primary healthcare settings provide an optimal environment for youth substance use prevention services. Pediatricians build relationships with youth and families throughout the youth’s childhood. Pediatricians can use routine well-child checkups as natural opportunities to monitor youth behavioral health, especially in early adolescence (as recommended by the American Academy of Pediatrics).
• Assesses for overall risks. Rather than screening for the presence of a substance use disorder, early preventative screening focuses on overall risk. This assessment identifies youth who have, or are at-risk of, early initiation of substance misuse. For example, the Youth Risk Index (YRI) is a cartoon-based, audio-supported, and computer-assisted screening tool that assesses multiple domains of risk (e.g., irritability, susceptibility to peer pressure) that are related to substance use.
  • In a study involving youth, parents, and pediatric staff, YRI screening was found to be universally important and easy to complete during well-child visits (taking about 8 minutes in a waiting room).
• Links to brief family-based prevention intervention. Family involvement is a protective factor of youth substance misuse; thus, effective youth substance misuse prevention efforts have leveraged family-based interventions. For example, the Family Check-Up is a brief, low-cost, highly-effective, family-focused intervention that addresses risk factors associated with early adolescent substance use and other problem behaviors.

Considerations for Policymakers and Healthcare Professionals

• Support prevention programs with demonstrated returns on investment (ROI) and potential cost savings. While additional research is needed, preliminary findings on the cost-effectiveness of the Family Check-Up program shows expected benefits to participants, hospitals, and taxpayers are likely to outweigh the costs of the program. Examples:
  • The YRI is $24 per screening. The Family Check-Up is approximately $1066 annually per family on average, or $480 per Family Check-up session and $107.19 per additional counseling session, which is lower than many other prevention programs.
  • In comparison, adolescent risky behaviors, including substance use, cost billions of dollars annually in the U.S., highlighting the need for effective prevention programs.
  • A strong evaluation plan would enable further examination of where cost savings may be realized.
• Strengthen reimbursement structures. Billing codes and insurance reimbursements to remunerate providers could cover screening and prevention services and already fund similar services.
• Promote partnerships across sectors and with payors. Partnerships with healthcare systems, insurance companies, community organizations, and schools can increase the reach of this model.
• Integrate innovative models into accessible settings. Pediatric primary care is a natural and optimal setting to provide prevention services. Pediatricians report that co-locating a family therapist in their practice to conduct screening and prevention resolved historical barriers to this service.