SUBSTANCE ABUSE PROGRAM
ADOLESCENT MEDICINE SUBSPECIALTY RESIDENTS AND CLINICAL FELLOWS
HOSPITAL FOR SICK CHILDREN
ROTATION OBJECTIVES
During this rotation, subspecialty residents participate in the care of adolescents with problems
related to alcohol and substance abuse. They provide adolescent health care as well as consultation
to other subspecialties caring for adolescent patients (both inpatient and outpatient), and are able
to follow patients in the Adolescent Medicine clinic.
Subspecialty residents provide assessment and treatment to adolescents with substance abuse
difficulties. They conduct comprehensive health assessments with patients referred to the
Outpatient and Day Treatment Substance Abuse Programs. They participate in a weekly health
teaching group for patients attending the Substance Abuse Day Treatment Program. They
participate in weekly clinical rounds as members of the Substance Abuse clinical teams. They also
have the opportunity to participate in some of the outreach education activities that occur at local
schools and community agencies.
Subspecialty residents attend rounds on the inpatient concurrent disorders unit at CAMH (Centre
for Addiction and Mental Health) and also attend a variety of outpatient clinics at CAMH (including
tobacco cessation, and medical/opiate clinic).
While this rotation focuses on the CanMEDS roles of Medical Expert, Communicator and
Collaborator, it is expected the trainee will demonstrate proficiency in all spheres.
The following objectives will be achieved during this rotation over the 2 years of the Training
Program.
The subspecialty resident will be able to:
Medical Expert
1) Demonstrate an understanding of the impact of substance abuse on the normal and
abnormal growth and development of an adolescent’s health and well-being.
2) Apply the concepts of risk behaviours, harm reduction, trans-theoretical model of change,
motivational model, positive youth development and resilience as they relate to adolescents
with substance abuse.
3) Identify and assess adolescents with concurrent disorders (co-existing substance abuse and
mental health disorder(s) or co-existing mental health disorders).
4) Describe the indications and consideration of (1 st year), and prescribe and/or assess the
suitability of (2nd year) commonly used psychotropic medications appropriate for use with
adolescents with concurrent disorders.
Revised September 2015
5) Select most effective therapeutic modalities to use with adolescents and their families who
are experiencing difficulties relating to substance abuse (individual, family, group, CBT as
examples).
6) Demonstrate an understanding of the epidemiology, prevention, risk factors, identification
and evaluation of tobacco, alcohol and other substance use and abuse in adolescents.
7) Describe the pharmacokinetics of substance use/abuse and the implications of polysubstance use/ abuse.
8) Describe and/or manage withdrawal, dependence and overdose of the most frequently used
substances.
9) Describe (1st year) and administer (2nd year) commonly utilized screening tools (GAIN SS,
CRAFFT) used with adolescents with substance abuse.
10) Demonstrate an understanding of the ethical issues pertaining to confidentiality and
consent to treatment for adolescents engaging in high risk health behaviours such as
substance abuse.
Communicator
1) (1st year) Demonstrate appropriate interviewing skills with adolescents and their families.
2) (2nd year) Demonstrate skills relating to effective short-term counseling for adolescents and
their parents.
3) Establish positive, ethical therapeutic relationships with adolescents and their families that
are characterized by understanding, trust, respect, honesty and empathy.
4) Communicate effectively with family members involved in the adolescent’s health care
where appropriate.
5) Seek out and synthesize relevant information from other sources, such as the adolescent’s
family, caregivers and other professionals as appropriate.
6) Provide clear and thorough explanations of diagnosis, investigations and management to
adolescents and when appropriate to their families, while respecting the adolescent’s legal
and ethical rights.
7) Demonstrate effective and timely verbal and written communication skills, including:
communicating with patients and families, verbal presentation of consultations,
documentation and consult letters, and use of EMR systems.
Collaborator
1) Demonstrate an understanding of the roles and responsibilities of other professionals
within the interprofessional teams in the Substance Abuse Program.
2) Demonstrate an understanding of the role of the health care practitioner as an advocate for
adolescents with substance abuse.
3) Identify and utilize collaborative strategies to participate effectively and appropriately in an
interprofessional healthcare team, and proactively work with other team members to
prevent misunderstanding, manage difference and resolve conflict.
4) Develop, implement and monitor an effective management plan in collaboration with others
involved in the adolescent’s care and life, including the adolescent and his/her family when
appropriate.
5) Identify the indications for referral of an adolescent to a mental health professional.
Manager
1) Integrate into care planning an understanding of the just allocation of healthcare resources,
balancing effectiveness, efficiency and access with optimal patient care.
Health Advocate
1) Support the health of adolescent patients by appropriate referrals, support and information
on health maintenance, lifestyle, and community/home resources.
Scholar
1) Maintain and enhance professional activities through ongoing learning, reflecting on
learning issues in practice. Critically evaluate medical information and its sources, and
apply this appropriately to practice domains.
Professional
1) Exhibit appropriate professional behaviors in practice, including honesty, integrity,
commitment, compassion, empathy, responsibility, respect, and an appreciation of
diversity; fulfill the regulatory and legal obligations required of current practice.
2) Demonstrate an awareness of personal limitations and seek guidance and/or feedback
when necessary.