A Quality Improvement Initiative to Enhance Screening and Referral for Adolescents and Young Adults With Opioid Use...

Background: Adolescents and young adults (AYAs) face increasing rates of opioid use disorder (OUD) yet remain underserved in access to medications for opioid use disorder (MOUD). Provider stigma, limited training, and inconsistent referral pathways contribute to low treatment uptake in community settings. Northern Virginia reports elevated rates of AYA overdoses and opioid-related emergency department visits, highlighting the need for coordinated, provider-focused interventions. Objective: To evaluate the acceptability, appropriateness, feasibility, and usability of a standardized screening and referral intervention designed to improve identification and referral of AYAs with OUD across suburban jurisdictions in Northern Virginia. Methods: This mixed-methods quality improvement initiative was guided by Lippitt's Change Theory and the Knowledge-to-Action Framework. Providers participated in an intervention consisting of asynchronous educational modules, live webinars, and use of a standardized screening and referral algorithm. Four Plan-Do-Study-Act cycles informed iterative refinements. Quantitative evaluation included the Acceptability of Intervention Measure, Intervention Appropriateness Measure, Feasibility of Intervention Measure, and the System Usability Scale (SUS). Qualitative evaluation included six think-aloud sessions analyzed thematically to identify key usability, feasibility, and implementation themes. Results: Fifteen providers participated in the intervention. Posttraining survey respondents (n = 5) reported high acceptability (M = 4.9), appropriateness (M = 4.75), feasibility (M = 4.6). Usability was rated as excellent (SUS = 82.5). Thematic analysis of six think-aloud sessions supported the algorithm's clarity, structure, and clinical guidance, particularly for providers with less experience, while identifying opportunities for refinement. Conclusions: Standardized screening and referral tools paired with provider education improve identification and referral of AYAs with OUD. Implications for Nursing: Nurses can lead OUD screening and referral efforts to support early intervention, reduce gaps, and enhance coordinated care for AYAs.