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SMART Choices Program Helps Fight Opioid Abuse in Children and Adolescents

By Ellen Mazo, Director, Government Affairs, UPMC Children’s Hospital of Pittsburgh, Western Psychiatric Institute and Clinic of UPMC

From rural areas and small towns to large cities, the opioid epidemic has affected every community in Pennsylvania. That’s why protecting the next generation from its stronghold is the goal of UPMC’s substance use-prevention efforts and its SMART Choices program.

UPMC recognizes that primary care providers have a unique opportunity during annual well-child visits to head off substance use and addiction before it becomes a lifelong problem.

For information about additional UPMC Addiction Medicine Services, call 412-692-CARE (2273).


Starting Early

You may wonder why pediatricians need to be involved in substance use prevention. Here are a few reasons:

    • It’s one of the leading causes of death and injury in adolescents.
    • Its financial impact on families is greater than that of diabetes or cancer.
    • Pediatricians are often the first line of defense against the potential lifelong health and family crises resulting from opioid use in children.
    • Accessing high-quality, specialized treatment early on is critical to preventing a cascade of substance use and abuse-related problems, opioid use in children, and death.

Taking a Holistic View

With input from researchers at the University of Pittsburgh, UPMC created a comprehensive assessment and intervention tool aimed at adolescents ages 11 to 18. UPMC Children’s Hospital of Pittsburgh and Western Psychiatric Institute and Clinic of UPMC launched the Screening Motivational Interviewing and Referral to Treatment (SMART) Choices program to train pediatricians on how to identify the risks for developing a substance abuse disorder.

The SMART Choices program is employed during an adolescent’s annual well-child or new-patient visit to screen for use of alcohol, tobacco, marijuana, and illegal and prescription drugs.

Once a child is identified as at risk for substance abuse disorder, pediatricians provide care and addiction services through:

  • Brief Intervention: If any risk is identified, pediatricians immediately provide brief in-office interventions, which have been effective in reducing drug and alcohol use.
  • Coordinated Care: If risk remains after the in-office intervention, the next step is referral to an in-office behavioral health therapist for a complete behavioral health evaluation. The behavioral health therapist provides early in-depth intervention, usually two to three sessions over three months. Care Coordinators and Parent Support Partners also offer individually tailored peer and family support over the phone to help monitor progress, offer encouragement and navigate care.
  • Virtual Intensive Family Support Team: If neither in-office intervention nor Coordinated Care are enough, a more intensive youth and family support service is provided. Offering virtual access through a facetime-like application, the care team can connect with families and provide support tailored to the needs of the youth.

Of the 41,575 adolescents screened in 2017 from July to December, 231 were identified as high risk. Often, those who require intensive support services are at the highest risk and struggle the most to access needed services. Adolescents who received intensive support became more successful in school, thereby reducing intervention costs. These intensive support services, currently implemented in 16 Pennsylvania counties, have lessened the need for inpatient hospitalization, out-of-home placement, and involvement with juvenile justice and child welfare.

What’s Next?

The SMART Choices program exists at all Children’s Community Pediatrics (CCP) locations. CCP is a Children’s Hospital subsidiary of 45 practices across western Pennsylvania. Pediatricians have embraced the program and screen about 7,500 adolescents each month. Since the program began on June 1, 2016, more than 98 percent of CCP adolescents have been screened during their annual well-child visits.


With additional funding, SMART Choices will be able to provide virtual intensive family support to many high-risk adolescents in up to 27 counties.

Pennsylvania isn’t alone in its fight against the opioid epidemic. As we continue to gather data on the progress of adolescents and families, we hope the SMART Choices program will become an effective nationwide model.

For information about additional UPMC Addiction Medicine Services, call 412-692-CARE (2273).


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