• Few studies (n=11) evaluated strategies to implement clinical interventions recommended by the Bright Futures Periodicity Schedule and the U.S. Preventive Services Task Force for preventing mental health and substance use disorders among children and adolescents.
• The implementation approaches identified in this report are complex, multifaceted approaches. We categorized studies as evaluating one of four overarching implementation approaches: incorporating behavioral health into primary care, engaging in learning collaboratives, providing support to clinicians, and using technology to facilitate screening or brief intervention. Studies were classified based on the primary implementation strategy employed, and in instances where multiple implementation approaches occurred, studies were categorized according to the most intensive implementation approach. Behavioral health incorporation was considered the most intensive, followed by learning collaboratives, providing support to clinicians, and finally, the use of technology.
• Implementation approaches consistently led to increased screening (reach) and a greater number of brief interventions and counseling for moderate-risk and high-risk behaviors (addressing a positive screen), and appropriate prescribing for mental health conditions (initiating treatment) compared with when no or minimal strategies were employed. Evidence assessing the impact of implementation approaches on patient outcomes was limited to clinian support, which did not improve risk behavior compared with educational material. Much of this evidence remains highly uncertain, with higher certainty for counseling than screening in some settings. 
• Studies comparing different implementation approaches generally reported comparable effectiveness, though individual outcomes occasionally showed differences. 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 insuffcient strength of evidence.
• No studies were identified that focused on the implementation of screening for anxiety or maternal depression among teenage mothers. Additionally, the 11 included studies failed to assess the acceptability or feasibility of the clinical intervention being implemented. Assessments of patients’ quality of life or adverse events were also absent. Furthermore, evidence was lacking on whether characteristics of the population, settings, care delivery, or the implementation strategy itself influences the effectiveness of implementation strategies.
• Despite the increase in screening and counseling that resulted from implementation approaches, the combination of limited evidence and lack of certainty about the available evidence highlights the need for more research on the impact of strategies to implement recommended screening and counseling interventions to prevent mental health disorders in primary care settings for children and adolescents.

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 October 6, 2023, 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 an insufficient strength of evidence rating. When compared to clinical interventions where only minimal or no strategies were employed, 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 insuffcient 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.