Special Circumstances for Declined Referrals
The following special circumstances may play a role in declined referrals:
- Many areas of an adolescent’s life may need to be evaluated and addressed at the same time as the substance use treatment (eg, trauma, sleep, anxiety, depression, and family system issues). Use motivational interviewing skills to help patients and families explore these issues and offer different treatment options (ie, mental health, which may be a more affordable and acceptable first step) to promote increased motivation to change.
- Some adolescents may experience special health care needs requiring collaboration with other providers to make the most appropriate referral. Like all adolescents receiving SBIRT services, use motivational interviewing skills to help patients and families explore the intersection of the substance use issues with the special health care needs. Consider the following examples:
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About the Adolescent
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About the Referral
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Tyrone is a 14-year-old male with Asperger’s syndrome (autistic spectrum disorder) who has developed severe cannabis use disorder.
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This adolescent may work better with individual providers rather than more intensive programs involving standard treatment in groups.
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Emily is a 16-year-old female with rheumatoid arthritis and multiple crises that have contributed to her anxiety. Emily uses prescription opioid and sedatives outside of their prescribed use.
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Communication and collaboration between subspecialty teams should ideally occur to ensure adequate, appropriate pain management when needed, with ongoing supports to help manage symptoms and prevent SUD escalation.
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- Offer different treatment options to maximize ownership of the patient’s own treatment.
- Consider instances where Child Protective Service involvement or emergency evaluations may be necessary to curtail associated harm.