Improving the Quality of Adolescent Opioid and Substance Use Services in Primary Care

About This Grant

Project Summary The recent rise in adolescent overdose deaths have overwhelmingly involved opioids, particularly illicitly manufactured fentanyl. With illicitly manufactured fentanyl increasingly present in a variety of illicit substances and counterfeit pills and with other substance use (e.g., cannabis, alcohol) predictive of future opioid misuse in adolescents, there is a critical need to target not only opioid use but all substance use among adolescents and to ensure adolescents have access to opioid use disorder (OUD) and other substance use disorder (SUD) services to prevent overdose deaths. Integrating OUD/SUD services into primary care is an approach that may increase the accessibility and availability of adolescent OUD/SUD care. However, when adolescents do receive OUD/SUD services, the quality of these services can vary markedly, with this care not always being timely, developmentally appropriate, or in line with the evidence base. Resultingly, adolescents may drop out of services prematurely or not attain desired outcomes. Thus, a focus on quality alongside access is needed to ensure available OUD/SUD care is safe, timely, effective, and developmentally appropriate. The proposed mentored career development award seeks to improve access to high-quality adolescent OUD/SUD care in primary care through two research aims. In Aim 1, the candidate will define quality indicators for adolescent OUD/SUD care in primary care by conducting a Modified Delphi study with multidisciplinary experts and using existing healthcare quality frameworks. Aim 2 will entail developing a single-session strategies for implementation (S3) approach targeting primary care providers to facilitate implementation of high-quality adolescent OUD/SUD care (Aim2a) and piloting the S3 approach with primary care providers in pediatric primary care clinics to evaluate the S3 for preliminary implementation and effectiveness outcomes (Aim 2b). To conduct this research, the candidate requires training and mentorship in four key areas to address current gaps in training: 1) develop expertise in advanced implementation research (Drs. Aalsma, Adams, Schleider, Wiehe), 2) training in qualitative and mixed methods (Drs. Aalsma, Vest), 3) training in administrative data usage (Drs. Aalsma, Mazurenko, Wiehe), and 4) specialized training in evidence-based OUD and SUD services for adolescents (Dr. Adams). The proposed research and training plan will inform future implementation efforts aimed at improving access to high-quality adolescent OUD/SUD services in primary care and support the candidate’s development as an independent clinical researcher and implementation scientist focused on improving the quality of OUD/SUD care for adolescents in healthcare settings.