Literature Collection

The purpose of the Engagement Behavior Framework is to present a realistic and comprehensive picture of what individuals must do in order to benefit from the health care available to them. Specifying these behaviors allows the public and other stakeholders to understand the magnitude and scope of the challenges people face in finding and using safe, decent care. This framework provides a basis for concrete, measurable expectations for individuals' behavior that should guide the reorientation of care toward patient-centeredness. It constitutes the first step in an effort to track and monitor engagement in the nation and among vulnerable subgroups. Better information about who does and does not perform each of these behaviors will allow stakeholders to make strategic decisions about the kind of information, guidance and support that are needed by their patients, members or constituents to participate effectively in their care and thus to benefit optimally from it.

The comprehensive health care integration (CHI) framework promotes the delivery of integrated physical and behavioral health care to adults and children in community settings by providing a flexible integration approach for both physical and behavioral health settings, including ongoing measurement of outcomes linked to payment methodologies. The CHI framework demonstrates value, strengthening alignment between provider organizations and payers to support service integration at implementation and on an ongoing basis.

BACKGROUND: Medication treatment for opioid use disorder is effective, and is recommended for adolescents, although very few adolescents with opioid use disorder ever receive medications. Reasons include lack of trained medication prescribers for this age group and difficulty in identifying adolescents with substance use disorders. This paper examines a novel implementation model of identifying and providing treatment for substance use disorders, including opioid use disorder, in a pediatric primary care practice. METHODS: Patients presenting to a selected primary care pediatrics practice for any reason between March 9, 2017, and July 24, 2017, who were identified by screening, self-report, or other clinical information to have a substance use problem were referred to an integrated clinical social worker for treatment. The authors recorded the number of patients who were referred, number of visits completed, and substance use disorder and mental health diagnoses. RESULTS: In the first 4 months of this program, 683 patients aged 12-22 completed a health maintenance appointment; 20 were referred for substance use disorder treatment and 13 completed at least 1 substance use disorder treatment visit with the integrated clinical social worker. The mean number of visits completed was 5.3. Three patients with opioid use disorders were identified, and 2 were induced on buprenorphine. CONCLUSIONS: The current model for treatment of substance use disorders, including opioid use disorders, was feasible and acceptable in a pediatric primary care practice. Broadly implemented, such a model could substantially increase access to substance use disorder treatment for adolescents and young adults.