Systematic Review: Implementing Recommended Mental Health and Substance Use Screening and Counseling Interventions in Primary Care Settings for Children and Adolescents. Content last reviewed April 2025. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD.
ABSTRACT
Objectives. To assess the impact of implementation strategies for mental health and substance use screening and counseling for children and adolescents in primary care as recommended by the United States Preventive Services Task Force and Bright Futures Periodicity Schedule.
Data sources. PubMed®, PsycInfo®, Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature®, as well as gray literature sources, reference lists, and technical experts.
Review methods. We followed the Agency for Healthcare Research and Quality Methods Guide for Effectiveness and Comparative Effectiveness Reviews, adapting it with classifications from the Expert Recommendations for Implementing Change (ERIC) and the Effective Practice and Organisation of Care (EPOC) taxonomies. We searched for studies published from January 1, 2010, through July 26, 2024, and selected studies that compared strategies for implementing mental health and substance use screening and counseling interventions for children and adolescents in primary care with another implementation strategy or no strategy. We evaluated randomized and nonrandomized controlled trials and interrupted time series studies. Studies conducted outside the United States were evaluated separately.
Results. We included 11 studies from the United States and 2 from other countries. Studies focused on screening and counseling for depression and suicide risk, eating disorders, substance use disorders, and general behavioral health risk factors. Implementation approaches were multifaceted and consisted of learning collaboratives, providing support to clinicians, adding new team members to incorporate behavioral health into primary care, and using technology. Overall, our confidence in the available evidence was limited, with numerous outcomes receiving a very low strength of evidence rating. When compared to clinical interventions where only minimal or no strategies were employed, the use of implementation strategies consistently resulted in higher screening rates and increased initiation of treatments. Few studies assessed patient outcomes, and clinician support neither reduced risk behaviors nor increased referrals for specialty substance use treatment. Different types of implementation approaches appeared to have comparable effectiveness. The evidence on the impact of implementation strategies on inequities in the delivery of recommended interventions for populations at risk for disparities was limited to a single study focused on clinician support for screening for depression and suicide risk, and yielded very low strength of evidence. We did not identify any studies on implementation of screening for anxiety or maternal depression among teenage mothers. Furthermore, none of the included studies assessed the acceptability or feasibility of the implementation approaches utilized, nor were patients’ quality of life or adverse events assessed.
Conclusions. The identified implementation approaches may increase screening and brief interventions. The evidence, however, is uncertain. Different types of implementation strategies appear to have comparable effectiveness.
