Closing the Gap: Strengthening Substance Use Support Within Child Psychiatry Access Programs

When a pediatric primary care provider suspects a teenager is struggling with substance use, they often have little to no training in how to handle it. Adolescent substance use is complex to address, and with too few addiction specialists available to see young patients, many providers are left without a clear next step.

A Model to Help Pediatricians

Jayme Congdon, MD, MS, associate professor in the UCSF Department of Pediatrics and the Philip R. Lee Institute for Health Policy Studies, recently examined how child psychiatry access programs (CPAPs) help clinicians care for adolescents with substance use concerns.

CPAPs were designed to connect primary care providers with specialists and resources for behavioral health conditions that fall outside their core training, but the study found that many of these programs offer little guidance beyond initial screening.

California’s CPAP, the California Child and Adolescent Mental Health Access Portal (Cal-MAP), is directed by UCSF and supports more than 3,000 pediatric providers across all California counties. Cal-MAP offers free consultation, training, and guidance that extends to substance use – support that remains limited in many statewide and regional programs.

What the Research Found

The study, published in the Journal of Adolescent Health, assessed resources across all 58 active CPAPs in the US and Canada. While 74% of these programs offered depression resources, fewer than 60% offered any substance use resources. Only 22% had substance use clinical pathways, compared to 45% for depression.

The gap was sharpest around opioid use disorder. Buprenorphine – the first-line medication treatment for opioid use disorder in youth, shown to reduce opioid mortality by 50% – was supported by an initiation protocol at just two programs. Harm reduction strategies were also largely absent.

“Pediatricians often lack the knowledge and experience to manage substance use themselves, and there are too few addiction specialists who see youth,” says Congdon. “As a result, many young people face significant barriers to receiving timely, evidence-based care for substance use.”

Congdon notes that stronger support could include standardized clinical pathways, detailed medication guidance, harm reduction strategies, and educational resources for both clinicians and families.

Building on the Foundation

With support from the Mount Zion Health Fund, Congdon and colleagues are working to expand and formalize Cal-MAP’s substance use resources further.

Working with colleagues across UCSF Pediatrics and Psychiatry – including Chuan-Mei Lee, MD, MA, William Burrough, MD, MPH, and Evan Holloway, PhD, MA – the team will assess the substance use support needs of UCSF pediatricians and expand Cal-MAP’s consultation and educational resources. They also plan to collaborate with programs nationally to share and potentially centralize resources.

“The opportunity now is to continue building on that foundation so that substance use support becomes as visible, accessible, and comprehensive as support for other behavioral health conditions,” says Congdon.

As programs like Cal-MAP expand their substance use services, the goal is to ensure that any pediatrician in California, regardless of training or location, has a clear path forward when a patient needs help.