Improving Screening for Adolescent Substance Use and Mental Health in Primary Care

Area of Science:

• Adolescent Health
• Primary Care Medicine
• Mental Health Services
• Substance Use Disorders

Background:

• Co-occurring mental health and substance use issues negatively impact adolescent outcomes.
• The Transformative and Evidence-based Approaches to Mental Health and Substance Use Screening (TEAMSS) initiative aimed to improve screening and follow-up for these issues in primary care.

Purpose of the Study:

• To enhance the implementation of screening and follow-up practices for adolescent substance use and mental health concerns within primary care settings.
• To evaluate the effectiveness of a virtual learning collaborative model in improving these clinical processes.

Main Methods:

• The TEAMSS initiative involved 160 clinicians across 27 pediatric primary care clinics.
• Interventions focused on screening, brief intervention, and follow-up for substance use, depression, anxiety, and suicide risk, adapted to a virtual learning collaborative format.
• The program incorporated individualized coaching and shorter, interspersed learning and action periods.

Main Results:

• Participating clinics standardized screening and intervention processes, adopted validated tools, and increased EHR/mobile device use.
• Screening rates significantly improved: substance use from 35% to 75%, depression from 82% to 90%, anxiety from 32% to 69%, and suicide risk from 18% to 41%.
• Follow-up for positive substance use screenings increased from 69% to 86%.

Conclusions:

• The TEAMSS initiative successfully enhanced care for adolescent substance use, depression, anxiety, and suicide risk in primary care.
• Adapting virtual learning collaboratives requires careful attention to maintaining engagement with busy clinical teams.