Implementing Screening and Counseling for Adolescent Mental Health and Substance Use

Abstract

CONTEXT: The proportion of US adolescents experiencing mental health or substance use disorders continues to rise. Pediatricians are expected to deliver evidence-based screening and counseling, but multiple barriers impede implementation. OBJECTIVE: This systematic review assessed the effectiveness of implementation strategies—activities to enhance implementation, service, and health outcomes—to support integration of screening and counseling for mental health and substance use disorders (MHSUD) into primary care for children and adolescents. DATA SOURCES: We searched multiple databases for literature published since 2010. STUDY SELECTION: Eligible studies compared any strategy to support implementation of a recommended intervention to prevent MHSUD among individuals aged 18 years or younger in primary care with another strategy or no strategy. DATA EXTRACTION: We extracted data on study designs, populations, settings, clinical interventions, barriers and facilitators to implementation, implementation interventions and comparators, and results. RESULTS: Eleven studies focused on implementing screening and counseling for depression, eating disorders, substance use disorders, and general behavioral health risk factors. Implementation approaches were multifaceted and consisted of incorporating behavioral health providers into primary care, facilitating learning collaboratives, providing support to clinicians, and using technology. These approaches generally resulted in increased screening, taking steps to address a positive screen, and initiation of treatment compared with using only minimal or no strategy. LIMITATIONS: Multifaceted and overlapping implementation approaches evaluated in few studies with limited evidence on patient outcomes constrained our ability to make inferences. CONCLUSIONS: The identified implementation approaches may improve some aspects of identifying and addressing MHSUD in primary care. The evidence, however, is limited.