Health professional perspectives on integrating substance use services into pediatric hospitals for adolescents with chronic medical conditions

Abstract

Adolescents with chronic medical conditions (A-CMCs) are at elevated risk for alcohol and substance use (SU) and its adverse health consequences, yet screening and intervention remain limited in pediatric hospitals. This study identified barriers and facilitators to SBIRT implementation within an urban pediatric hospital, using the Learning Health System (LHS) framework and the Consolidated Framework for Implementation Research (CFIR) to embed SU prevention into routine clinical care. Guided by CFIR, we conducted semi-structured interviews with 26 multidisciplinary hospital staff. Interviews were analyzed deductively using CFIR domains to elucidate determinants influencing SBIRT implementation, with attention to LHS principles of continuous learning and data-driven improvement. Facilitators included provider perception of SBIRT effectiveness, alignment with existing hospital workflows, electronic health record integration with decision support tools, and engagement of behavioral health staff, which are all consistent with LHS mechanisms of routine data use and continuous learning. Barriers included high patient acuity in the pediatric emergency department and inpatient settings, insufficient SU screening protocols, competing workload priorities, unclear role responsibilities, billing challenges, and concerns regarding SU stigma among patients and families. Participants emphasized that implementing SBIRT in pediatric inpatient settings requires multi-level strategies that leverage LHS strengths such as embedded data capture, real-time decision support, and continuous quality improvement cycles to overcome barriers. Addressing identified barriers via workflow piloting, standardized screening tools, leadership alignment, and training may enhance system capacity. Future research should evaluate LHS-enabled implementation models for SBIRT to scale equitable SU interventions within pediatric hospital settings.