The CRAFFT 2 1 Manual

The Crafft 2 1 Manual-Free PDF

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The CRAFFT 2 1 Manual,INTRODUCTION 2,WHAT IS NEW IN THE CRAFFT 2 1 3. USING THE CRAFFT 2 1 4,Which version of the CRAFFT 2 1 should I use 4. How do I administer the CRAFFT 2 1 4,Determining the CRAFFT Score 5. Determining Risk Level 6,BRIEF ADVICE INTERVENTION 7. Exemplar Cases Using 5 R s Approach for Brief Intervention 9. Low Risk 9,Medium Risk 10,High Risk 14,DIAGNOSING A SUBSTANCE USE DISORDER 18.
riding driving risk and substance use disorder among youth ages 12 21 It is brief and efficient. enough to be used as part of universal screening efforts in busy medical and community health. settings and yields information that can serve as the basis for early intervention and counseling. to enhance motivation for behavior change It is the most well studied adolescent substance use. screener available and has been shown to be valid for adolescents from diverse socioeconomic. and racial ethnic backgrounds You may view publications at this website. http ceasar childrenshospital org crafft crafft publications It is recommended by the. American Academy of Pediatrics Bright Futures Guidelines for preventive care screenings and. well visits the Center for Medicaid and CHIP Services Early and Periodic Screening Diagnostic. and Treatment EPSDT program and the National Institute of Alcohol Abuse and Alcoholism. NIAAA Youth Screening Guide The CRAFFT 2 1 is an updated version of the original. CRAFFT with revisions based on recent research regarding screening methods and validity. Why universal screening of adolescents, Substance use usually begins during adolescence 1 making prevention and early intervention. programs that target this age group the logical way to reduce costs and gain productive years of. life Universal screening of adolescents is a promising strategy for identifying substance use. before more serious problems develop and primary care settings offer an excellent venue for. screening prevention and early intervention Greater than three in four adolescents see a. primary care provider yearly and have trusting longitudinal relationships with their providers 2. Moreover routine primary care visits give providers and their patients an opportunity to have a. private conversation and teachable moment about sensitive health topics Recognizing this. opportunity the American Academy of Pediatrics recommends that all adolescents receive. substance use screening as part of routine care 3, Why use a standardized screener validated for adolescents. Studies show that relying on non validated screening questions or one s gut impressions can. lead to underestimating the presence of adolescent substance use problems 4 In addition some. screeners used with adults such as the CAGE screener have been shown to perform poorly. among adolescents 5,The CRAFFT 2 1 Manual,WHAT IS NEW IN THE CRAFFT 2 1. The CRAFFT 2 1 now incorporates opening questions inquiring about the frequency of past 12. month use of alcohol or other substances in place of the previous opening questions that asked. yes or no questions about any past 12 month use,Previous Questions. During the past 12 months did you Yes No,Drink any alcohol more than a few sips.
Smoke any marijuana or hashish,Use anything else to get high. New CRAFFT 2 1 Questions, During the past 12 months on how many days did you of days. Drink more than a few sips of beer wine or any drink. containing alcohol Say 0 if none, Use any marijuana weed oil or hash by smoking vaping or. in food or synthetic marijuana like K2 Spice Say 0. Use anything else to get high like other illegal drugs. prescription or over the counter medications and things that. you sniff huff or vape Say 0 if none, A recent study examining the validity of the opening yes no questions found relatively low. sensitivity in identifying youth with any past 12 month alcohol or marijuana use 62 and 72. respectively 6 Research suggests that yes no questions about sensitive topics may have greater. potential for motivated underreporting and social desirability bias than questions that ask how. many or how often which implicitly convey an expectation of the behavior 7 Therefore we. modified the opening questions to ask about past 12 month frequency on how many days and. included the instruction Say 0 if none to normalize non use We then tested the validity of these. questions in a screening study of adolescent primary care patients Compared to the criterion. standard of a research staff administered confidential Timeline Follow Back Interview we found. that the frequency questions had improved sensitivity in identifying adolescent alcohol and drug. use 79 and 86 respectively compared with that found for the yes no questions in the prior. study 6 For the opening questions the highest sensitivity is preferred to avoid missing anyone who. may be at risk,The CRAFFT 2 1 Manual,USING THE CRAFFT 2 1.
Which version of the CRAFFT 2 1 should I use, There are two versions of the CRAFFT 2 1 a Clinician Interview and a Self administered. Questionnaire Research has found that adolescents report greater comfort and likelihood of. honesty with self administered questionnaires in the waiting room either electronically or on. paper compared to face to face interviews 8 9 The self administered version is also more time. efficient to administer than an interview 10 Therefore we recommend the use of the Self. administered Questionnaire Appendix A whenever possible under conditions that protect. patient privacy and confidentiality The responses can then be used by the healthcare provider. during the appointment to facilitate brief counseling. To ensure confidentiality some offices set aside a private corner of the waiting room for the. patients to complete the screen pre visit Other offices find it more practical to have patients. complete the screen in the exam room prior to their appointment with their clinician The most. important principle is to ensure that parents cannot see their children s responses so that. adolescents feel comfortable reporting honestly,How do I administer the CRAFFT 2 1. If you choose to use the Self administered Questionnaire Appendix A we recommend. administering the questionnaire to youth on paper or on a tablet computer to complete on their. own in a private place within the clinical office setting The self administered version begins with a. statement about the confidentiality of their answers The patient then follows the written. instructions on how to complete the rest of the questionnaire. If you choose to use the Clinician Interview Appendix B we recommend that the healthcare. professional administer it verbally in a private setting with the patient without parents guardians. present to encourage honest answers Screening with the CRAFFT 2 1 Clinician Interview should. begin with a discussion of confidentiality We suggest starting the interview with a statement. similar to I am going to ask you a few questions that I ask all of my patients Please be honest All. of your answers to these questions will be kept confidential If I am concerned about your. immediate safety I will let you know so we can discuss further steps. Next ask the patient the three past 12 month frequency of use questions exactly as they are. worded in Part A of the CRAFFT 2 1 If the patient answers 0 to all the opening frequency. questions ask the CAR question only If the patient reports any days of use on any of the. frequency questions ask the full set of six CRAFFT questions. The CRAFFT 2 1 Manual, PART A has a 0 response for all Ask only the CAR question in PART B. frequency questions, PART A has a 1 response on any Ask all six CRAFFT questions in PART B. frequency question,Determining the CRAFFT Score, Part B of the CRAFFT 2 1 remains the same as in the original CRAFFT screener with the six items.
identified by the acronym CRAFFT each letter standing for the first letter of the key word Car. Relax Alone Forget Family Friends Trouble in each question The CAR question asked of all. respondents regardless of their substance use is a safety risk screener It assesses impaired driving. or riding with an impaired driver two leading causes of death for adolescents The remaining five. questions RAFFT assess substance related problems Each Yes response equals one point and. total CRAFFT scores therefore range from 0 6 In our original validation study 11 a score of 2 was. found to be the optimal cut point for identifying a DSM IV Substance Use Disorder SUD among. adolescents ages 14 18 sensitivity or the percentage of those who truly have a diagnosable. substance use disorder who are correctly identified 80 specificity or the percentage of those. who truly do NOT have a diagnosable substance use disorder who are correctly identified 86. We found the same optimal cut point in a subsequent study of adolescents ages 12 17 sensitivity. 88 specificity 94 10 A study by Mitchell and colleagues evaluating the CRAFFT score relative. to a DSM 5 SUD again found a score of 2 to be the optimal cut point among adolescents ages 12. 17 sensitivity specificity for detecting any DSM 5 SUD 91 93 for detecting a moderate or. severe SUD 88 87 12 Two studies by Kelly and colleagues13 14 examined the CRAFFT among 18. to 20 year old emergency department patients and found the optimal cut point to be a score of 3. sensitivity 82 specificity 67 Another recent study found an optimal cut point of 4 for alcohol. screening among adults age 18 25 sensitivity 81 specificity 45 Screening for cannabis use. using this cut point yielded similar values sensitivity 84 specificity 49 This research suggests. that a higher cut point should be used for young adults age 18 compared to youth younger than. 18 years Although specificity is rather low for the higher age groups it is more important to have. high sensitivity given that the CRAFFT is a screening tool whose purpose is to identify those who. may require further assessment Studies to date have given no indication that there should be. different cut points by gender or race ethnicity, The bar chart below shows the positive predictive value the percent of screen positives that are. true positives of each CRAFFT score for identifying adolescents meeting DSM 5 criteria for a. The CRAFFT 2 1 Manual,Substance Use Disorder 12, As shown by the rising bars the CRAFFT has scale like properties with higher CRAFFT scores. indicating a higher likelihood that the adolescent meets criteria for a DSM 5 Substance Use. Disorder SUD of any level mild moderate severe CRAFFT scores of 4 5 and 6 had 54 70. and 100 positive predictive values respectively for identifying patients with a moderate or. severe SUD, This bar chart is included on the reverse side of the CRAFFT card and CRAFFT Interview form. After determining a patient s CRAFFT score the provider can ask the patient to find where his her. score falls on the bar chart explaining that this is the percentage of adolescents with the same score. that were found to have a substance use disorder in prior studies This gives an indication of the. probability that an adolescent based on his her CRAFFT score will have recurring problems. related to use of alcohol and drugs,Determining Risk Level. The following table describes the criteria defining the risk level categories which can guide the. providers conversation with the patient based on the CRAFFT 2 1 screening results. A low risk patient is defined as one that reports NO use in the past 12 months and answers. NO to the CAR question CRAFFT score of 0,Medium risk could be met in two ways.
NO use in the past 12 months and YES to the CAR question. ANY use in the past 12 months and CRAFFT score of 0 or 1. Youth are considered high risk if they report any use in the past 12 months and have a CRAFFT. The CRAFFT 2 1 Manual,total score of 2 or more,Risk Level CRAFFT Score Clinical Action. Provide information about risks of, No use in past 12 months and CRAFFT substance use and substance use. score of 0 related riding driving offer praise,and encouragement. No use in past 12 months and Yes to Provide information about risks of. CAR question only OR substance use and substance use. Use in past 12 months and CRAFFT related riding driving brief advice. score 2 possible follow up visit,Provide information about risks of. Use in past 12 months and CRAFFT substance use and substance use. score 2 related riding driving brief advice,follow up visit possible referral to.
counseling treatment, The following sections in this manual describe a framework for brief provider counseling the 5. R s for each of these risk levels,BRIEF ADVICE INTERVENTION. Delay of substance use by any amount during adolescence a sensitive period for brain. development allows for unhindered brain maturation and reduces risk for addiction 15 There is. growing evidence that brief advice or intervention delivered by primary healthcare providers can. delay or reduce adolescent substance use 16 17 Interventions employing the tech. life Universal screening of adolescents is a promising strategy for identifying substance use before more serious problems develop and primary care settings offer an excellent venue for screening prevention and early intervention Greater than three in four adolescents see a

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