TABLE 4

Suggested Proficiencies for Pediatricians

Level 1: For all health professionals with clinical responsibility for the care of children and adolescents:
 Be aware of the medical, psychiatric, and behavioral syndromes and symptoms with which children and adolescents in families with substance use present and of the potential benefit to both the child and the family of timely and early intervention.
 Be familiar with and able to direct families to community, regional, and state resources available for children and adolescents in families with substance use.
 As part of the general health assessment of children and adolescents, health professionals include appropriate screening for family history and current use of alcohol and other drugs by parents.
 Use motivational interviewing techniques (asking screening questions, developing discrepancy, expressing empathy, avoiding argumentation, rolling with resistance, and supporting patient self-efficacy), assist families in identifying problems substance use can cause and reasons a person may want to quit or cut back.75
 Assist parents who screen positive and identify treatment options.
 Offer information, support, and follow-up for parents who screen positive.
 Understand state mandatory child abuse reporting laws and know how to make a report to the responsible investigating agency.
Level II: In addition to Level I proficiencies, health care providers accepting responsibility for prevention, assessment, intervention, and coordination of care of children and adolescents in families with substance use may:
 Apprise the family of the nature of SUDs and their effects on all family members and strategies for achieving optimal health and recovery.
 Recognize and treat, or refer, all associated health problems in the child.
 Evaluate resources (physical health, economic, interpersonal, and social) to the degree necessary to formulate an initial management plan.
 Determine the need to involve extended family and other support people in the initial management plan.
 Develop a long-term management plan in consideration of the above standards and with the child’s or adolescent’s participation.
Level III: In addition to Level I and II proficiencies, the health care provider with additional training, who accepts responsibility for long-term treatment of children and adolescents in families with substance use, may:
 Acquire knowledge, by training or experience, in the medical and behavioral treatment of children in families affected by substance use.
 Throughout the course of health care treatment, continually monitor and treat, or refer for care, any health needs or psychiatric or behavioral disturbances of the child or adolescent.
 Acquire knowledge, by training or experience, of the recovery process and gain an understanding of how to establish and evaluate screening, brief intervention, and referral to treatment systems in practice.75
 Request consultation as needed.
 Be available to the child or adolescent and the family, as needed, for ongoing care and support.
  • Adapted with permission from Adger et al (1999).74