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Screening tool helps to identify at-risk children

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Nurses can use a simple screening tool to identify children and adolescents at high risk from parents who misuse drugs, US nurse researchers say.

They studied 121 young people, aged 13–19, who reported having a parent or family member with a substance misuse problem.

Using a 30-question survey, the Children of Alcoholics Screening Tool (CAST), the authors rated the adolescents’ risk of being affected by their parents’ addiction as ‘low’, ‘moderate’ or ‘high’.

Children judged to be in the high risk group had significantly more medical conditions and reported more negative moods than those in the other groups.

‘Children of substance-abusing parents frequently present to nurses or primary care providers with vague physical complaints, such as stomach ache and headache,’ the authors said.

‘Nurses can use CAST to assess the severity of parental substance abuse and its impact on adolescents’ physical and emotional health,’ they added.

They said the screening tool, which requires no special training and only takes 5–10 minutes to administer, can also be used by nurses to guide a personal interview with a child.

Gerry Byrne, a consultant nurse and child psychotherapist with Oxfordshire and Buckinghamshire Mental Health Trust, said: ‘Studies have shown [parental] drug and alcohol abuse to be a common factor in child maltreatment cases.

‘Although we tend not to routinely ask about these areas, including substance misuse in the children, CAST appears easy to use and relatively straightforward to interpret. It would be worth considering in all child and adolescent mental health services.’

But Sue Anderson, school nurse team leader for Bath and North East Somerset PCT, warned the tool could be too intrusive for some children. ‘The questions are very direct and personal. We could use elements of the tool to encourage a child to open up but the approach should not be too rigid.’

Journal for Specialists in Paediatric Nursing (2008) 13: 15–25

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