A number of years ago, I found my way into the Child and Youth Mental Health and Substance Use Community of Practice (CYMHSU) Community of Practice, a provincial network of family doctors, psychiatrists, pediatricians, clinical counselors, and people with lived experience who decided to work together to improve care. What started as a grassroots effort to connect practitioners across the province has grown into something remarkable. Police officers in Surrey have been trained on how to approach youth without re-traumatizing them. We’ve held workshops on the neuroscience of trauma, resiliency-informed practice, and positive parenting. We have brought people with lived experience into the room, and their stories have shifted how clinicians see their work in ways that no lecture ever could.
At the heart of this collaborative sits a tool that I wish every family doctor in BC knew about: the Youth Substance Use Clinical Care Pathway, available on the PathwaysBC website.
Co-created by physicians from UBC CPD, Foundry BC, BC Centre for Substance Use, Interior Health Authority, and PathwaysBC, the pathway gives clinicians clear, accessible resources for navigating substance use conversations with young patients and their families. It covers everything from mental health disorders to local resources for safe supply, detoxification, and rehabilitation.
Dr. Shirley Sze, a family physician, one of HDC’s founders, and member of the Substance Use Working Group of the CYMHSU Community of Practice, helped drive the creation of this pathway. “We were motivated to create an interactive point of care clinical care pathway tool for physicians that would increase their confidence, support them in management and team-based care, and provide referral resources for ease of accessibility,” she explains. “Drawing upon our experts in addiction medicine and pediatrics, we pay particular attention to the biopsychosocial environment and the developmental stages of youth, which is unique and different from adult substance use disorder.”
Youth substance use is not simply a smaller version of adult addiction. It requires a different lens, one that accounts for where a young person is developmentally, what is happening in their home, their school, their community, and what they are trying to cope with when they reach for a substance.
One of the most sobering things I have encountered in this work is what the data actually shows us. At a recent CYMH CoP night gathering with colleagues, we reviewed the community’s data on mental health and substance use across our neighborhoods via HDC Discover. We also pulled additional EMR data from our own practices. The clinical picture was concerning enough. But what struck me just as much was how many social history fields were sitting blank. For those who may not know, every EMR has a social history section. It is where we document living situations, substance use, and support systems. For patients under 25, this information is clinically essential.
And here is what I keep coming back to: research tells us that simply asking a young person about substance use, in a non-judgmental and curious way, meaningfully reduces the likelihood that experimentation becomes dependence. The conversation itself is an intervention, and we don’t need a perfect system to start having it.
A participant in the CYMHSU online learning module described how this approach has already begun to shift their practice:
“This education [shifted] my practice towards a youth-centered, autonomy-focused approach, prioritizing trust-building through the mature minor framework and motivational interviewing.
I can better support marginalized groups by integrating culturally appropriate and safe resources and addressing the root causes of minority stress.”
If this article resonates with you, or if you recognize something in the blank fields of your own EMR, I would encourage you to start somewhere small. Here are some ideas of where to start:
- Ask a simple screening question at your next appointment with a young patient
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- Take the UBC CPD short CYMHSU online learning module
- Spend twenty minutes reviewing Youth Substance Use Clinical Care Pathway
- View your practice’s Youth Mental Health population in HDC Discover. If you’re not using HDC Discover yet, get started here.
- Once you are set up with HDC Discover, review your mental health measures:
- Mental Health with alcohol use disorder https://prod.hdcbc.ca/measures?id=1197
- Mental Health with substance use disorder https://prod.hdcbc.ca/measures?id=1213
- Mental Health with cannabis use disorder https://prod.hdcbc.ca/measures?id=1194
The people I see navigating addiction on the streets of Surrey were once young. Many of them had family doctors and sat in a room very much like yours.
We may not always get to see the difference one conversation makes, but we can’t help if we don’t ask.