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Cohen Children’s Medical Center to ask adolescent patients about substance use


To combat the growing opioid epidemic here on Long Island, Cohen Children's Medical Center (CCMC), the stand-alone children's hospital of Northwell Health, New York's largest health system, will begin asking patients ages 12 and older about their substance use, beginning January 8, 2018.

This new initiative is an age-appropriate adaptation of the health system's existing Screening, Brief Intervention, and Referral to Treatment (SBIRT) program, which promotes the "We Ask Everyone" process. Originally instituted for adult patients presenting to select Northwell Emergency Departments and Primary Care Practices, the protocol is designed to universally screen patients. Evidence-based questions are utilized to determine the patient's level of risk and if they may benefit from support or treatment for their substance use.

"This is one of many steps we are taking across the Northwell health system to help our communities combat this national health crisis," said Jay Enden, MD, chair of the health system's Opioid Management Steering Committee. "It is a vital step to standardized practices that better address substance use and the opioid crisis. It is a service to our communities, patients and employees."

In 2015, the Center for Disease Control 's (CDC) Youth Risk Behavior Surveillance System (YRBSS), revealed that for New York State high school students (grades 9-12), 7.6 percent reported using cocaine, 4.8 percent used heroin and 3.4 percent injected illegal drugs compared to 5.2, 2.1 and 1.8 percent respectively for students nationwide.

The decision was made to expand the SBIRT program within Northwell based on the successful implementation at other Northwell tertiary and community hospitals, and the SBIRT team's incorporation of the "addressing substance use" curriculum at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. "We need to rethink the way we approach the topic," said Sandeep Kapoor, MD, director of Northwell's SBIRT program. "By normalizing the conversation, building trust with our patients, and valuing the importance of identifying substance use and its clinical relevance, we are taking a step in the right direction." At Cohen, social workers and front-line Emergency Department nursing and physician teams have been trained to use the SBIRT screening tool. Dr. Kapoor stated, "It's important to address this crisis with a team-based approach to better support our patients and their families."

"We are creating structured opportunities to engage and discuss substance use with our patients," said Jahn Avarello, MD, division chief of Pediatric Emergency Medicine at Cohen. "Adolescence is a critical time due to the exponential risk for abuse and addiction among those who start using substances before the age of 18 compared to those who do not start use until adulthood."

"Children and adolescents are impacted by this crisis just as much as adults," said Charles Schleien, MD, executive director of Cohen Children's Medical Center. "We see it time and time again. It is in the news, in our communities, in people's homes and in our schools.We need to use every tool in our arsenal to help educate our community and identify problems so each of us has a greater awareness and the ability to intervene in this crisis and save lives."

In addition to screening at its hospitals, Cohen and the Northwell Opioid Management Steering Committee reached out to all school superintendents in Nassau and Suffolk counties during the first week of January with a survey. By reaching out to determine current issues communities and districts are facing regarding substance use, they hope to identify opportunities that may benefit from partnership.

Dr. Schleien said that coordination throughout the Long Island community is essential. "With the understanding that there is no stand-alone solution, education and awareness are critical elements in making a positive impact in our communities. We are confident that building bridges and forming partnerships with our surrounding school systems and community organizations will better align efforts currently underway, and provide opportunities for innovation and dissemination."

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About Northwell Health
Northwell Health is New York State's largest health care provider and private employer, with 23 hospitals, more than 600 outpatient facilities and nearly 15,000 affiliated physicians. We care for over two million people annually in the New York metro area and beyond, thanks to philanthropic support from our communities. Our 66,000 employees – 15,000-plus nurses and 4,000 employed doctors, including members of Northwell Health Physician Partners – are working to change health care for the better. We're making breakthroughs in medicine at the Feinstein Institute for Medical Research. We're training the next generation of medical professionals at the visionary Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and the Hofstra Northwell School of Graduate Nursing and Physician Assistant Studies. For information on our more than 100 medical specialties,

About the Steven and Alexandra Cohen Children's Medical Center of New York
Founded in 1983, Cohen Children's Medical Center is a 202-bed hospital dedicated exclusively to the care of children. The specialists in the hospital's national and international programs cover an entire range of specialties. State-of-the-art care for children's medical, surgical, and dental needs are provided in both inpatient and outpatient settings. The facility is the largest provider of pediatric health services in New York State, serving 1.8 million children in Brooklyn, Queens, and Nassau and Suffolk Counties. For the 11th consecutive year in 2017, Cohen's was ranked among the nation's best children's hospitals in U.S. News & World Report's 2017-18 "America's Best Children's Hospitals" survey, achieving top-50 rankings in nine of 10 pediatric specialties.

Brian Mulligan
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