CRAFFT 2.1 SCREEN

Date: [Date]
Patient: [Name or ID]
Age: [Years; the tool is for ages 12 to 21]
Setting: [Well visit, sports physical, school-based clinic, urgent or emergency visit, or mental health intake]
Version and format: [CRAFFT 2.1 or 2.1+N; self-completed on paper or tablet, or clinician interview; language]

PRIVATE TIME
Seen alone: [Minutes, and which part of the visit]
Confidentiality: [What stays private and its limits, such as serious risk of harm or abuse; explained to the teen, the caregiver, or both]
Caregiver during the screen: [Out of the room, or present and why]

PART A: DAYS IN THE PAST 12 MONTHS
Alcohol: [Number of days, 0 if none]
Cannabis: [Number of days, and how: smoked, vaped, edibles, or concentrates]
Anything else to get high: [Number of days, and what: pills, inhalants, or other drugs]
Vaping or tobacco, 2.1+N only: [Number of days, and the yes answers on the nicotine part]
Asked next: [Car question only, or all six]

CRAFFT SCORE
Yes answers: [0 to 6]
Questions answered yes: [Car, relax, alone, forget, family or friends, trouble; or none]
Cutoff used: [2 or more, or your service's cutoff]
Risk level: [Lower risk at 0 to 1, or high risk at 2 to 6]

FOLLOW-UP QUESTIONS
Pattern: [What, how much, how often, with whom, where, and the most recent use]
Effects on daily life: [School, sleep, sport, mood, injuries, blackouts, or legal trouble]
Mood and self-harm: [Depression or anxiety screen result, self-harm questions, or not done]
DSM-5 criteria: [Criteria met and severity, referred for assessment, or not indicated]

RIDES AND DRIVING
Rode with an impaired driver: [No, or yes: who, when, and how often]
Driving status: [Not driving, learner, or licensed; driven after using: no, or yes and when]
Safe-ride plan: [Who the teen will call, the plan agreed with the caregiver, Contract for Life given]

BRIEF INTERVENTION
Talking points covered: [Results reviewed, advice not to use, ride risk, the teen's own reasons, confidence]
Teen's response: [Their words, and any goal they set]
Readiness: [0 to 10 rating if used]

REFERRAL AND FOLLOW-UP
Referral: [None needed, adolescent substance use counselor, specialist program, or mental health care]
Shared with caregiver: [What was shared and the teen's agreement, or kept confidential]
Next screen or visit: [Date or interval]

Clinician: [Name, credentials]