November 21, 2025
Project Overview: Bay Clinic, a trusted community healthcare provider serving families in Coos Bay since 1955, recently completed a four-month Quality Improvement (QI) project focused on Adolescent Substance Use, sponsored by the American Academy of Pediatrics (AAP). They were joined in the Oregon cohort by Virginia Garcia FQHC pediatric provider Kim Cummings, MD. Bay Clinic summarized their key learnings with us so that we could share with the OPS community.
Project Components: The MOC-IV project required Bay Clinic to establish a multidisciplinary QI team, which included two pediatric providers—Jon Yost, MD and Charles Toledo, MD—along with a nurse, medical assistant, social worker, and community health worker. The clinical team met monthly to review materials and implement changes. Participants attended four comprehensive webinars covering adolescent substance use and addiction; SBIRT (Screening, Brief Intervention, and Referral to Treatment); treating opioid use disorder in pediatric settings; and overdose prevention and harm reduction strategies. Throughout the project, they collected and reported data on at least 10 charts monthly while receiving quality improvement coaching and learning from teams across multiple states.
Key Learnings and Practice Changes:
- Prevention Counseling with Negative Screens: Bay Clinic discovered the critical importance of discussing substance use prevention even when SBIRT screenings are negative. By engaging youth in prevention conversations during every adolescent patient visit, providers create opportunities for reflection that may influence their future choices and help them develop healthier decision-making skills.
- Improved Communication Techniques: The AAP cohorts were supported in approaching substance use discussions with empathy and active listening rather than judgment. One effective practice change the Bay Clinic team implemented was asking more open-ended questions. For example, instead of “Are you vaping?” (which invites a simple yes/no response), asking, “When did you vape last?” This reframing encourages youth to reflect honestly on their behavior, and the team finds that patients who don’t vape simply say so. Project participants also gained valuable insights into navigating confidentiality while appropriately involving parents in treatment discussions.
- Limited Adolescent-Specific Resources: Through this project, Bay Clinic identified a significant gap in substance-use services specifically tailored for adolescents, particularly in rural communities. Agencies providing substance-use treatment are designed primarily for adults, which underscores the importance of pediatricians developing strong SBIRT skills and prevention counseling capabilities. Oregon primary care providers may be the first—and for some time the only—point of intervention for those struggling with substance use. Bay Clinic is actively exploring and building connections with resources that better serve this population.
Project Benefits: Participation provided Bay Clinic with evidence-based materials, access to subject matter experts, quality improvement coaching, and valuable peer learning through interactive discussions with other state teams—all of which have strengthened their capacity to address adolescent substance use in Coos County.
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Our sincere thanks to Bay Clinic and Dr. Cummings for their participation in this project. If you or your clinic is interested in participating in upcoming quality improvement projects, or would like to train your clinic staff in REALD & SOGI information collection or youth suicide prevention best practices, please reach out to Program Coordinator Caroline Garrett.
