Screening, early identification, and office-based intervention with children and youth living in substance-abusing families

All health care professionals with clinical responsibility for the care of children and adolescents must be able to recognize, as early as possible, a ssociated health problems or concerns in children of substance-abusing pare nts, and to be able to assist these children and families in seeking treatm ent and promoting health. Health care providers can have a tremendous influ ence on families of substance-abusing parents because of their understandin g of family dynamics and their close longstanding relationship with the fam ily. Information about family alcohol and other drug use should be obtained as part of routine history-taking and when there are indications of family dysfunction, child behavior or emotional problems, school difficulties, an d recurring episodes of apparent accidental trauma, and in the setting of r ecurrent or multiple vague somatic complaints by the child or adolescent. I n many instances, family problems with alcohol or drug use are not blatant; rather, their identification requires a deliberate and skilled screening e ffort. Combining the principles of anticipatory guidance, screening, and early ide ntification, with the acknowledgment that families should be included in th e process, leads to a clear conclusion that screening for children affected by parental substance abuse must occur at all ages across infancy, childho od, and adolescence. Health care providers need to be trained in the identi fication and management of children and youth exposed to parental addiction . Such training must begin during undergraduate education in the health pro fessions and be reinforced by role-modeling among health professions facult y as well as practicing providers.