Manual para la Detección e Intervención Temprana del Consumo de Sustancias Psicoactivas y Problemas de Salud Mental en los Servicios de Salud Amigables para Adolescentes y Jóvenes

Objectives

Strengthen Colombia’s Friendly Health Services for Adolescents and Young People (SSAAJ) as a primary-care setting for prevention, early detection, brief intervention, referral and follow-up for mental-health problems and psychoactive-substance use among adolescents and young people. The manual supports the prevention component of the National Policy and Plan for the Reduction of Psychoactive Substance Use and aligns with national drug-use-reduction and mental-health plans.[1][2][3]It aims to provide integrated, timely, quality and youth-friendly support that reduces gaps in care, morbidity, mortality, disability and the progression or chronicity of problems emerging during adolescence.[4][2][5]

• Integrate mental-health and substance-use support into comprehensive SSAAJ provision, alongside sexual and reproductive health services, recognising associations with HIV, other sexually transmitted infections, adolescent pregnancy and other vulnerabilities.[4][6]
• Identify mental-health concerns, risky or harmful substance use, dependence and associated social, sexual and family vulnerabilities early, while treating screening as risk assessment rather than diagnosis.[7][8][9]
• Provide brief, proportionate support that promotes awareness of risks, motivation for change, harm reduction and access to appropriate further care.[10][11][12]
• Refer users requiring more complex assessment, treatment or continuing support to secondary, tertiary or specialised services, while maintaining continuity of care through referral, counter-referral and follow-up.[3][13][14]
• Apply a differential, culturally responsive and whole-person approach that considers individual, relational, environmental, community and sociocultural circumstances, and enables young people’s participation in social change.[4][15][16]
• Prioritise promotion of health and quality of life, prevention of risk, recovery and mitigation of harm, including preventable violence and mental-health-related vulnerability.[3]

Implementation

Deliver the model through an adaptable five-step care pathway spanning identification, screening, initial brief intervention, referral or treatment at the appropriate level, and case follow-up. Three steps are undertaken within SSAAJ and two at other levels of care; territorial entities are expected to adapt the pathway to local capacity, service models and available networks.[17][18]The pathway is intended to reinforce existing non-specialised and youth-friendly services rather than depend on a large additional specialist service offer.[4][18]

• Embed case identification in routine clinical history-taking by asking actively about substance use, emotional state, behaviour, relationships, sleep, eating, sexuality, daily functioning, family support and contextual risks.[7][5][19]
• Apply screening selectively after clinical enquiry suggests need, except where the guidance calls for annual substance-use screening within health-promotion activity; conduct it confidentially, conversationally and without stigmatising or pressuring the user.[19][9][20]
• Use validated tools suited to age and purpose, including the Alcohol Use Disorders Identification Test (AUDIT), Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), Report Questionnaire for Children (RQC) and Self-Reporting Questionnaire (SRQ).[10][21][22]
• Interpret screening collaboratively with the user, score instruments promptly, compare relevant findings with International Classification of Diseases, 10th Revision criteria where needed, and avoid treating a score alone as diagnostic confirmation.[23][24][25]
• Deliver brief interventions based on screening findings through empathy, feedback, personal responsibility, professional guidance, alternative options and support for self-efficacy. Use a structured process to review results, assess the situation, discuss change, agree goals and summarise next steps.[26][27]
• Tailor support to stages of change, including pre-contemplation, contemplation, preparation, action, maintenance and relapse, while recognising relapse as a possible part of change.[27]
• Refer cases involving dependence, significant mental-health concerns, psychotic symptoms, urgent needs or complexity beyond SSAAJ capacity to identified receiving institutions, and minimise administrative barriers to onward care.[13][28][29]
• Establish directories and networks of public, private, institutional and community providers, including specialised treatment services, community support, youth groups and relevant social organisations; coordinate referral and counter-referral with territorial authorities, providers, insurers and community actors.[30][31][32]
• Assign clear team responsibilities, train doctors, psychologists, nurses and other SSAAJ staff in detection, screening, brief intervention, referral and administrative procedures, and designate pathway coordination functions for linking referral and follow-up.[33][34][31]
• Maintain follow-up through contact with receiving institutions, case databases, recorded communications, scheduled appointments and counter-referral reports. The guidance includes follow-up intervals such as every 15 days for reports from partner institutions, every two months for service follow-up, or approximately three to four months after referral, depending on the pathway component.[30][35][36]
• Use existing financing and billing arrangements where identified, including the Public Health Collective Interventions Plan for some demand-generation, screening and network-building activities, and the Compulsory Health Plan for specified consultations, education, referral-related care and some higher-complexity services.[37][10][38]

The supplied material identifies surveillance reporting during case identification and operational follow-up mechanisms, but does not specify a comprehensive system of performance indicators, reporting schedules, audit arrangements, evaluation targets or formal accountability structures for the overall pathway.[34][36]It also provides billing routes and tariff references for selected activities but no quantified budget, unit costs, funding allocation or financing gap.[39][14]

Monitoring & Evaluation

Monitoring centres on clinical detection, screening, referral, counter-referral and follow-up within Adolescent and Young People Friendly Health Services (SSAAJ), rather than on a comprehensive programme-level performance framework. The pathway uses clinical records, screening scores, diagnostic review and contact with receiving providers to guide individual case management.[3][34][36]

• Maintain reporting of identified cases to surveillance systems during clinical-history taking and case identification, although the source does not specify the surveillance platform, reporting frequency or data standards.[34]
• Use screening as a risk-assessment tool rather than a diagnosis, supported by clinical history, scoring guidance and, where needed, comparison with International Classification of Diseases, 10th Revision criteria.[7][23]
• Apply validated screening instruments for substance use and mental health, including the Alcohol Use Disorders Identification Test, Alcohol, Smoking and Substance Involvement Screening Test, Reporting Questionnaire for Children and Self-Reporting Questionnaire.[23][20][21]
• Interpret instrument performance through sensitivity, specificity and positive predictive value, comparing results with external clinical diagnostic standards and recognising the service and financial consequences of false-positive and false-negative results.[40][41]
• Use defined scoring thresholds to determine intervention intensity. Alcohol Use Disorders Identification Test scores of 0–7 lead to education, 8–15 to simple advice, 16–19 to advice, brief therapy and continuous monitoring, and 20–40 to specialist referral.[42]
• Assess Alcohol, Smoking and Substance Involvement Screening Test results separately by substance and overall risk, with alcohol scores of 0–10, 11–26 and above 27 indicating low, moderate and high risk respectively; the corresponding thresholds for other substances are 0–3, 4–26 and above 27.[43][44]
• Escalate mental-health assessment and referral where screening indicates concern. A positive Reporting Questionnaire for Children response signals a possible problem requiring diagnostic comparison, while positive Self-Reporting Questionnaire responses in psychosis-related items 21–25 indicate serious symptoms or immediate referral needs.[22][45][29]
• Track cases managed within SSAAJ, referred to higher levels of care or connected to community services through referral and counter-referral processes.[33][18]
• Maintain a database of referred users, record contacts and calls, liaise with receiving institutions, and schedule follow-up intervals, including examples of every two months, approximately three to four months after referral, and a minimum follow-up report every 15 days through inter-institutional coordination.[30][35][36]
• Review pathway processes and procedures at territorial level after local adaptation, using process diagrams and descriptive matrices to clarify actions, potential findings and available tools.[32][46]
• Work towards the stated 2014 target of at least two friendly services in every departmental and district territorial entity incorporating early-detection and brief-intervention strategies for mental-health and psychoactive-substance-use comorbidity risk.[2]

Beyond these clinical and service-follow-up mechanisms, the material does not specify a unified indicator set, reporting schedule, audit process, evaluation methodology, named accountability body or formal performance targets for the mental-health and substance-use pathway.[33][31][19]

Costing & Financing

Financing is principally framed through use of existing health-service capacity, the Compulsory Health Plan, the Public Health Collective Interventions Plan and specified billing routes, rather than through a quantified implementation budget. The material promotes strengthening existing SSAAJ provision and adapting pathways to territorial capacity, avoiding an extensive additional specialist service offer that may be difficult to sustain.[4][18][37]

• Define financing and care-management mechanisms for the pathway with actors in the General System of Social Security in Health, territorial authorities, providers, insurers and institutional or community partners.[33][32]
• Assign demand-generation activities and mental-health or psychoactive-substance-use screening in first-level state social enterprises to the Public Health Collective Interventions Plan.[37][10]
• Cover case reception, clinical-history preparation and case-identification activity through relevant medical, nursing or health-education consultations under the Compulsory Health Plan, according to the service delivered.[37]
• Use billing routes for individual education and crisis intervention according to the professional or educational agent providing the activity; some listed activities have no corresponding 2010 SOAT tariff-manual code.[47][35]
• Charge partial hospitalisation, inpatient mental-health-unit care and specified medium-complexity drug-dependence care to the Compulsory Health Plan, using the cited Agreement 008 and 2010 SOAT tariff references.[38][14]
• Recognise that universal mental-health screening is described as costly and impractical, supporting selective use based on clinical history and judgement; brief intervention is described as cost-effective in the cited literature.[48][21][12]

No monetary budget, unit cost, tariff amount, allocation, funding-gap estimate, resource-mobilisation target or economic assumption is provided. The cited codes identify billing or tariff references only and do not supply prices.[39][38][8]