Overview: Due to the high risk of substance use in the population of students that Hillcrest Educational Centers (HEC) serves, HEC is committed to the prevention, identification and treatment of substance use. Abstinence from all drugs and alcohol is expected of students at all times throughout their placement at HEC (including home and community visits). Services focused upon supporting abstinence, psychoeducation, and preventing future substance use are provided to all students in care. HEC does not provide primary treatment for substance use, and therefore has very limited specific substance use treatment services.  Based on results of screening or any subsequent assessment, substance use treatment may be deferred, referred out, or if significant, may be cause for recommending a change in placement.  Student’s, whose use is identified as instrumental or more serious, are planned for on an individualized basis utilizing the following treatment recommendations. Students determined to be habitual and compulsive users of one or more substances are likely to need alternative placement. 

Please note:  HEC does not admit students who are in need of detoxification or rehabilitation related to Substance Use Disorder, or students for whom this is the primary treatment need. Students that have secondary treatment needs related to substance use (i.e. trauma reactive youth who engage in experimental substance use) will be considered for admission. 

Substance Use Screening:  Within 24 hours of admission, a substance use screening tool will be administered to all youth by clinical staff.  Hillcrest currently utilizes the CRAFFT Screening Tool.  

Clinicians utilize the CRAFFT Provider Guide and scoring indicators to determine next steps.  CRAFFT scoring indicates the following:

0 = Client who report no use of alcohol or drugs; provide praise and encouragement to the youth.

0 or 1 = Client who reports any use of alcohol or drugs; encourage client to stop and provide brief advice regarding the adverse health effects of substance use utilizing psychoeducational materials.

2 to 6 = Client is identified with a “positive” screening; score indicates that the client is at high-risk for having an alcohol or drug-related disorder and requires further assessment. 

For youth whose CRAFFT screening indicates a need for further assessment, Hillcrest utilizes the Substance use Subtle Screening Inventory (SASSI).  The full assessment tool will be utilized within the first 45 days of placement. Stakeholders and collaterals will also be contacted during the diagnostic period. Findings from this screening and any subsequent full assessment will be included in the youth’s Diagnostic Psychosocial Assessment, which is due within 45 days of admission. Along with consideration of the other components of the student’s diagnostic psychosocial assessment, and in consultation with the treatment team,  treatment recommendations are proposed.  When indicated, a course of treatment will be included in the student’s Comprehensive Treatment Plan (CTP). 

Ongoing Treatment: Hillcrest provides psychoeducation to students with a history of substance use in addition to the recommended interventions listed within the SASSI IF these interventions are within the scope of Hillcrest’s treatment.  These recommendations are utilized to develop their comprehensive treatment and are reviewed quarterly for progress and revision. As noted above, for identified treatment needs outside of the scope of Hillcrest’s treatment, other steps may need to be taken.

Drug screens may be ordered for alcohol, amphetamines, cocaine, morphine, marijuana, phencyclidine, benzodiazepines, methadone, barbiturates, and tricyclic antidepressants by the treating psychiatrist or pediatrician.  An order for drug screening may occur as a means of supporting treatment goals for any student assessed to be instrumental or more serious in their use.  Additionally, a drug screening may occur if any student is suspected or disclosed to have engaged in substance use (at any point during their treatment and placement at HEC). Drug testing requires consent of the student’s guardian and is implemented according to the agency drug testing policy. 

Students who are believed to be under the influence or who have disclosed present substance use (other than from nicotine or as prescribed by a physician) will be assessed by the campus nursing staff or taken to urgent care or emergency department for assessment if indicated. Suicide risk should be considered as a possible motivator for acute substance misuse and the agency suicide prevention policy should be utilized when indicated. 

 

Drug Testing Procedure 

Overview: Drug testing will occur according to the treatment plan, or as ordered by the physician based on the recommendations/outcome of the clinical assessment process. Once consent is obtained, nursing staff will complete the mouth swabs and urine collection for testing. If students do not return to campus when there is a nurse on campus, the supervisor on duty will obtain and store the specimens as instructed. 

General Procedure: When a student has been identified in need of drug testing, the following process must occur prior to drug testing: 

1. The Clinical Department will notify the Nursing Department of the assessed need for drug screening and what drugs should be included in the screening panel. 
2. The psychiatrist or the physician will be notified by nursing, and if in agreement, an order will be written for the specific drugs that the student will be tested for. 
3. The Clinical Department will notify the parent/guardian of the findings and recommendations from the Substance Use Screening and obtain consent from the guardian for any drug testing that has been recommended. The guardian and/or primary family contact will also be informed of the process. 
4. The Clinical Department will inform the Nursing Department when consent has been given for drug testing. 

 

Procedure After Testing is Complete: 

1. Nursing will forward a copy of the test results in the form of personal notification 

to the administrative staff, supervisor on duty, the psychiatrist and the appropriate clinician within 24 hours after testing. This can be via email, voice mail or in person. 

2. The student’s clinician, or designee, will notify the guardian and/or primary family contact of the outcome of the test. 
3. Nursing will clearly note the results in a log for future identification and date of the test for the student. These results will also be uploaded to the nursing file uploads within the student’s chart.  
4. The rest of the treatment team will be notified within 7 days by the clinical designee.  

Procedure if Student Returns to Campus After a Home Leave With Physical Symptoms With Suspicion of Drug Use: 

On the occasion when a student returns to a campus with physical evidence of substance use, i.e., elevated vital signs, altered mental state, and there is suspect of drug use: 

1. Nursing will do an assessment noting the student’s physical state, and if a consent is in place do a drug test. The student will be transferred to the ER for further evaluation and possible treatment if deemed necessary. 
2. If nursing is not on campus, the supervisor on duty will notify the Campus Administrator and notify the nurse on call.  The nurse will consult and may instruct the supervisor to send the student to the emergency room for further evaluation if deemed necessary..