Initial Insights from a Quality Improvement Initiative to Develop an Evidence-informed Young Adult Substance Use Program

Background High rates of substance misuse during emerging adulthood require developmentally appropriate clinical programs. Objectives This work outlines the development of an evidence-informed emerging adult outpatient substance use program, quality improvement process and protocol, and 1-year program insights. Methods Literature reviews, program reviews, environmental scans, and stakeholder consultations (including lived expertise) were used to develop the program. A 12-week emerging adult (17-25) measurement-based care program was developed including: 1) individual measurement-based care and motivational enhancement therapy sessions; 2) group programming focused on cognitive behavioural therapy, mindfulness, distress tolerance, and emotional regulation; 3) consults for diagnostic clarification and/or medication review; and 4) a separate education group for loved ones. A measurement system was concurrently created to collect clinical and program evaluation data at 6 time points. Results In the first year of the program, 96 young adults fully enrolled in the program (Mean age = 21 years old, 48% female gender) primarily reporting treatment targets of alcohol (70%) and cannabis (59%). Almost all patients (97%) surpassed at least one clinical threshold for co-occurring mental health disorder, with the median/mode of positive psychiatric screens being for 5 conditions. Conclusions This program demonstrates that developing an integrative evidence-informed measurement-based care young adult substance use program is feasible, though requires flexibility and ongoing monitoring to meet local needs. Patient characteristics reveal very high rates of concurrent psychiatric disorders in addition to substance use disorders.