Practical factors determining adolescent substance use treatment settings: Results from four online stakeholder panels

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Practical factors can significantly influence the setting, or level of care, where an adolescent receives substance use treatment. This study aimed to identify practical factors that stakeholders find most critical to consider when planning adolescent substance use treatment. We conducted online panels with four stakeholder groups: providers, policymakers, researchers, and parents. Stakeholders nominated, rated, and commented on the importance of 10 practical factors that could influence treatment setting decisions. We assessed consensus on the rated importance of practical factors using the RAND/UCLA Appropriateness Method. We thematically analyzed stakeholders comments to explain how they differentiated relative importance. 153 stakeholders (66 providers, 38 policymakers, 27 researchers, and 22 parents) identified continuity of care, coordination of care across service sectors, and quality of care as the practical factors of highest importance. Participants rated higher the practical factors they perceived to (1) trump clinical appropriateness as the reason for placing an adolescent in a given setting, (2) steer adolescents toward specific settings, or (3) steer an adolescent away from specific settings. Conversely, participants rated lower the practical factors they perceived (1) applicable to clinical intervention rather than treatment setting, (2) unrelated to initial recommendations, (3) relevant to any setting, or (4) applicable only to certain contexts and sub-populations. These findings help elucidate why stakeholders view certain practical factors as critical to consider in actual decisions about substance use treatment settings for adolescents. Future research should investigate how to incorporate these practical factors alongside clinical needs and treatment goals in placement criteria and treatment matching.