Hoover Adger, Jr, MD, MPH; Donald Ian Macdonald, MD; and Sis Wenger – 1999
The pediatrician’s responsibility for alcohol and other drug (AOD) problems among children, adolescents, and families has received increased recognition over the last decade. Although reaching a consensus about the scope of that responsibility has been challenging, several professional organizations and individuals have attempted to clarify the role of the pediatrician and of other primary health care providers who care for children and adolescents. The American Academy of Pediatrics took an important step forward by creating a set of guidelines for both pediatric education and clinical practice when it released its policy statement on The Role of the Pediatrician in Prevention and Management of Substance Abuse. This Statement noted that “inquiry regarding the extent of drug use should be part of the routine inquiry of every teenager presenting for periodic care,” (American Academy of Pediatrics, 1983). Macdonald and Blume (1986) agreed and expanded that perspective, pointing to the pediatrician’s unique and long-lasting relationship with the family, and recommended that physicians ask about family drinking and drug use as early as the first prenatal visit. The Ambulatory Pediatric Association went even further by developing guidelines for all primary care pediatricians regarding knowledge and skills related to AOD. Although these statements have helped to define the role of the pediatrician, they do not account for varying levels of interest, comfort, and skill among health providers. Moreover, the need to use preventive interventions that strengthen families and maximize opportunities for enhancing the health and welfare of children and adolescents has become increasingly more apparent. The Core Competencies for Involvement of Health Care Providers in the Care of Children and Adolescents in Families Affected by Substance Abuse is a set of statements that articulate three distinct levels of care. In addition, it attempts to recognize and account for the individual differences among health providers. It was developed in a manner not only to endorse a minimal role for all primary health care providers but to provide enough flexibility for individuals to choose their role and degree or level of involvement. Furthermore, it recognizes the central tenet that although primary care providers might be responsible for identifying the problem, they are not expected to solve, manage, or treat the problem by themselves. It is suggested that all primary health professionals with responsibility for the care of children, whatever their area of training or discipline, have a minimal level of competence that includes a basic understanding of the medical, psychiatric, and behavioral symptoms of children and adolescents in families affected by substance abuse; be familiar with local resources; appropriately screen for family history/current use of AOD; determine whether family resource needs and services are appropriate; and be able to express an appropriate level of concern and offer support and follow-up. The specific knowledge and skills indicated at level I of the core competencies are suggested as a baseline or minimal level of competence that all primary health care providers should strive to achieve. However, many will want to do more than indicated in level I competencies. For those who wish to be involved at a higher level, however, a different and more advanced set of knowledge and skills will be required. Most important, this is a decision that each provider can make for her/himself. Some will want to attain these additional knowledge and skills, whereas most simply will need to be able to collaborate with and refer to those who have the skill and expertise to provide these specialized services. The end result, however, is increased attention to an important problem and enhanced opportunities for validation, education, support, and treatment for patients and families affected by substance abuse. In summary, it is a vehicle for helping us to brighten the future for children who may be struggling with one of the families’ biggest and most burdensome secrets.