Key takeaways:
- A nationwide initiative helped pediatric clinics greatly improve adolescent behavioral health screening.
- Substance use screening more than doubled.
- Participating clinics increased screening for depression, anxiety and suicide risk, improving the likelihood that concerns are identified early.
- Clinics that implemented the new model continued to maintain the changes nine months after the project ended.
(SACRAMENTO)
A nationwide quality improvement initiative led by researchers and clinicians from UC Davis Health, the American Academy of Pediatrics and partner organizations resulted in significant increases in screening and follow-up care for adolescent substance use and mental health concerns across pediatric primary care clinics.
The findings are detailed in a new study published in the American Journal of Medical Quality.
The Transformative and Evidence-based Approaches to Mental Health and Substance Use Screening (TEAMSS) collaborative engaged 160 clinicians at 27 pediatric primary care clinics across 18 states. The project aimed to strengthen screening, brief interventions and follow-up practices for adolescents ages 12 to 18 during routine health visits.
Researchers found substantial improvements over the 11-month initiative:
- Substance use screening increased from 35% to 75% of adolescent well visits.
- Follow-up care for adolescents with positive substance use screenings increased from 69% to 86%.
- Depression screening increased from 82% to 90%.
- Anxiety screening increased from 32% to 69%.
- Suicide risk screening increased from 18% to 41%.
"Adolescents are facing overlapping challenges related to substance use and mental health, yet these issues often go undetected in routine care," said Ulfat Shaikh, professor of pediatrics at UC Davis Health and lead author of the study. "Our findings show that with the right support, coaching and evidence-based tools, primary care teams can dramatically improve screening and early intervention for young people."
Our findings show that with the right support, coaching and evidence-based tools, primary care teams can dramatically improve screening and early intervention for young people." -Ulfat Shaikh
Building sustainable systems for mental health and substance use screening
Mental health and substance use disorders frequently occur together and can worsen health outcomes if left untreated. National recommendations encourage routine screening, but implementation has often been limited by time constraints, lack of standardized workflows and insufficient resources.
To address these barriers, TEAMSS adapted the Institute for Healthcare Improvement's learning collaborative model for a virtual environment. Participating clinics received training, coaching, peer-to-peer learning opportunities, data feedback and practical tools to improve clinical workflows and adopt validated screening instruments.
Clinics implemented a range of evidence-based strategies, including:
- Standardized screening protocols.
- Use of validated screening tools such as CRAFFT, PHQ-9, GAD-7, and Ask Suicide-Screening Questions.
- Integration of screening into electronic health records.
- Mobile device-based screening workflows.
- Expanded involvement of interdisciplinary care teams.
- Development of community partnerships and referral networks.
More than 90% of participating clinicians reported that TEAMSS improved or significantly improved patient care and clinic operations. Nine months after the collaborative ended, 85% of clinics reported they had fully maintained the changes implemented during the project.
"Our virtual model allowed clinics across the country to participate regardless of geography," Shaikh said. "The combination of brief learning sessions, individualized coaching and peer learning helped practices build sustainable systems for addressing adolescent behavioral health concerns."
The researchers noted that while improvements in screening were substantial, future efforts should focus on expanding suicide risk screening, strengthening community partnerships and supporting resource-limited and rural clinics.
The study concludes that virtual learning collaboratives can serve as an effective, scalable approach for improving adolescent behavioral health screening and care delivery in primary care settings.
"One of my biggest takeaways from the TEAMSS project is that busy primary care clinics are eager to improve mental health and substance use care for adolescents when they have practical tools, peer support, and opportunities to learn from one another," Shaikh said.
"I am deeply grateful to the clinics, clinicians, and staff who participated in this work despite competing demands on their time," she added. "Their commitment to learning and improvement made this project successful and ultimately helps create better care for adolescents and their families."
