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

Abstract

Background: Mental health and substance use can coexist and worsen outcomes for youth. The goals of the Transformative and Evidence-based Approaches to Mental Health and Substance Use Screening (TEAMSS) quality improvement virtual learning collaborative were to enhance the implementation of screening and follow-up practices for adolescent substance use and mental health issues in primary care.

Methods: TEAMSS engaged 160 clinicians at 27 pediatric primary care clinics in 18 states. Interventions focused on enhancing clinical processes related to screening, brief intervention, and follow-up for substance use, depression, anxiety, and suicide risk. The learning collaborative model was adapted for a virtual environment with learning sessions and action periods of shorter duration interspersed with individualized coaching.

Results: Clinics standardized processes for screening and intervention, incorporated use of validated screening tools, increased the use of electronic health records and mobile devices in screening, engaged interprofessional team members, identified community resources, and increased clinician and staff knowledge of evidence-based guidelines and quality improvement methods. Substance use screening significantly increased from 35% to 75%. Follow-up of adolescents with positive substance use screening increased from 69% to 86%. Depression screening increased from 82% to 90%, anxiety screening increased from 32% to 69%, and suicide risk screening increased from 18% to 41%.

Conclusions: TEAMSS significantly improved care for substance use, depression, anxiety, and suicide risk for adolescents at participating primary care clinics. Adapting a learning collaborative approach to a virtual setting requires close attention to maintaining engagement with clinical care teams, especially those in busy primary care clinics.