The "Six T's": barriers to screening teens for substance abuse in primary care.
OBJECTIVE
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.
Van Hook
Shari
S
Medicine, Children's Hospital Boston, Boston, Massachusetts, USA. shari.vanhook@childrens.harvard.edu <shari.vanhook@childrens.harvard.edu>
Harris
Sion Kim
SK
Brooks
Traci
T
Carey
Peggy
P
Kossack
Robert
R
Kulig
John
J
Knight
John R
JR
D000293:Adolescent; D016497:Adolescent Health Services / Q000458:organization & administration* / Q000592:standards; D002648:Child; D003144:Communication Barriers; D005260:Female; D017144:Focus Groups; D006302:Health Services Research; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000458:organization & administration* / Q000706:statistics & numerical data; D020380:Needs Assessment; D009511:New England; D010287:Parent-Child Relations; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000458:organization & administration*; D018570:Risk Assessment; D015813:Substance Abuse Detection; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology; D014505:Urban Population