iHeLP: Implementation of Technology-Based Screening, Brief Intervention, and Referral to Treatment in Pediatric Primary Care

Key Outcomes

• Henry Ford Health adapted publicly available software (CIAS) to reach adolescents, whose substance misuse and other behavioral health concerns are often unaddressed.  
• The project resulted in high rates of patient and provider satisfaction with the tool, increased patient motivation to decrease substance use, and guided providers to more honest and fruitful conversations with youth. 
• The project significantly increased rates of screening and brief interventions for depression, anxiety, suicide-related thoughts and behaviors, and substance use in youth and is now standard practice throughout HFH pediatric primary care. 

Project Summary

Access to substance use screening for young people nationwide is underwhelming and spotty. The gap in standardized practices spans substances, age, and types of providers. Though the American Academy of Pediatrics recommends that pediatric primary care providers address substance use and mental health concerns, they’re often not trained to do so. HFH sought to build a program to reach youth that would communicate in their preferred modes and intervene to change behavior around substance use.  

To be successful in the clinic setting, the project quickly shortened the screening and intervention from 17 minutes to 3. Refocusing the product as a short, targeted tool was highly effective in increasing motivation and creating opportunities for conversations about substance use, mental health, and other often stigmatized topics. The approach also uses principles of motivational interviewing and readiness to change to query youth about their interest in follow-up interventions. For adolescents who opt in, the application can send texts and other messages to promote healthy behaviors. This ability to engage youth during the visit and afterward is crucial to the success of the program.  

Embedding the screener and intervention into the EHR and reducing administrative burden is also an essential piece of the solution, allowing staff and providers to focus on learning to navigate tricky conversations around teen substance use and mental health. As the application became the new standard of care, primary care providers requested expansion of the screener to include depression and mental health screening in addition to substance use.  

The adaptability of the publicly available, underlying software allows for continuous enhancements to meet the needs of providers and specific populations. While HFH is a large institution, the project was designed and implemented by a small team dedicated to optimizing the CIAS software for the adolescent population and providing technical assistance support to clinics. With a basic understanding of the software, organizations of all sizes can adapt and customize screenings tools to break down conversational barriers, meet patients where they are, and expand access to behavioral health screenings and interventions.