Literature Collection

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.

Syringe services programs are community-based prevention programs that provide evidence-based, lifesaving services for people who use illicit drugs, including access to syringes, naloxone, fentanyl test strips, infection screening, and linkage to treatment. Historically, syringe services programs did not exist within the Veterans Health Administration owing to many factors, including lack of clarity regarding legality for federal agency-purchased syringes. Three champions at Veterans Affairs facilities in Danville, IL, Orlando, FL, and San Francisco, CA, worked to clarify legal considerations, address barriers, and implement syringe services programs that are integrated in the health care systems. Since 2017, these 3 programs have engaged approximately 400 Veterans and distributed nearly 10,000 syringes, 2500 fentanyl test strips, 50 wound care kits, and 45 safer sex kits. These programs, both led by and in collaboration with clinical pharmacist practitioners, paved the way for nationwide implementation within the Veterans Health Administration. This commentary describes successes, challenges, and proposed next steps to increase Veteran access to syringe services programs, written from the perspective of 3 facility-based champions.