· Executive Brief
Red Ribbon Week 2026
A practical executive framework for access, ownership, handoffs, measurement, and improvement.
Leadership signal
Red Ribbon Week can serve as an executive operating checkpoint.
Awareness can generate questions and requests for help. Executive teams can prepare by clarifying the first point of contact, the qualified team that accepts the request, the handoff standard, and the method used to verify completion without assuming that one route fits every person.
Start by distinguishing what is known from what the organization still needs to learn. A campaign plan, communication volume, or meeting count does not establish that a route is usable. Leaders need direct listening, clear ownership, locally defined measures, and a method for keeping exceptions visible.
Executive opening
Red Ribbon Week is a test of the youth prevention pathway
Red Ribbon Week puts youth substance use prevention in front of schools, families and communities. For a health system, the week is also a chance to inspect an operating pathway. That pathway runs from school and community prevention through screening, brief intervention, referral and treatment entry. Each step depends on a different team, and many depend on partners outside the hospital. Schools, pediatric practices, emergency departments, trauma programs, probation agencies and community treatment providers all hold part of the route.
The research shows the pathway leaks at handoffs more than at awareness. At one level I pediatric trauma center, 434 of 683 injured adolescents (63.4%) underwent substance use screening.[3] Only 32 (36.4%) of those who screened positive had a documented referral to support services.[3] In probation settings, only 27% of youth with a substance use-only indicator were referred to treatment.[15] Nationally, about 31.0% of adolescents admitted for cannabis use disorder treatment waited more than one day for care.[4]
The same evidence shows the pathway can be repaired. A virtual learning collaborative across 27 pediatric primary care clinics in 18 states raised substance use screening from 35% to 75%.[1] Follow-up of adolescents with a positive screen rose from 69% to 86% in the same clinics.[1] Those gains came from operating work: standard processes, validated tools, electronic record prompts and engaged team members.
This brief adds the evidence base behind the executive guidance above. It covers burden, the continuum of care, access, equity, the workforce and public communication. The aim is a youth prevention pathway that leaders can own, measure and report on long after the campaign week ends. Throughout, the focus is how the system operates, not advice for any individual young person.
Current evidence
What the research says about burden, screening and prevention
Opioid harms are rising among young people even where overall use has eased. A study of tertiary-care children’s hospitals identified 4550 emergency department visits for opioid overdose from 2017 to 2022.[6] Those visits rose 20.2% over the period, and fatal overdoses rose 200%.[6] Youth aged 15 to 19 years accounted for 35.2% of visits, and most adolescent overdoses were intentional.[6] The study’s background notes that fatal opioid overdoses among children have increased 4-fold since 2018.[6] That finding ties substance use prevention closely to mental health and suicide prevention operations.
Screening remains inconsistent at the front door of primary care. In a 2023 national survey of 1047 youth-serving clinicians, 56.9% reported screening for substance use disorders at every well visit.[10] Only 39.3% screened at every well visit using a screening tool.[10] Just 30.7% offered all components of screening, brief intervention and referral to treatment.[10] Among pediatricians in a 2021 national survey, 41% usually used a standardized instrument.[8]
Reliable screening is achievable at scale with quality improvement methods. In a 34-site pediatric primary care network, the share of eligible adolescents screened rose from 0% to above 90% within 2 months.[14] During the network phase, 35,750 of 38,427 eligible patients (93%) completed the screening form.[14] Of those screened, 85% were low risk, 3% medium risk and 2% high risk.[14] Ten percent of results were not recorded in a way that allowed later risk assessment, a data quality gap worth noting.[14] Reliable screening also creates a steady stream of positive results that someone must be ready to receive.
School and family prevention also offers evidence that leaders can use with partners. A peer-led storytelling program run by a recovery community organization surveyed 10,438 Midwestern middle and high school students from 2014 to 2020.[9] Of 996 students who rated the program, 51.2% said they felt less likely to use alcohol or drugs afterward.[9] A randomized trial of a brief family-meals intervention enrolled 388 parents and 388 children.[7] Parents in the intervention arm reported more frequent conversations with their child about substances at 3 months.[7]
Most of these studies are observational, single-site or based on self-report. They show where the pathway works and where it breaks. They do not establish the size of any downstream health effect, and leaders should present them that way. Their value lies in pointing to the specific handoffs that a health system can redesign and measure.
Figure 1
Youth substance use pathways lose young people between screening and referral
Percent reaching a screening or referral step, as reported in each study (denominators differ). Values are copied from the cited studies [3], [10], [15]; none is estimated.
Data note. These values come from different studies, settings, years and denominators (adolescents in one chart, clinicians in another), so this is an indirect comparison that shows where the pathway leaks, not how one setting compares with another.
Limitation. Trauma center data are from one center; clinician values are self-reported; the probation data are from 2014 to 2017.
Figure data (5 rows)
| Measure | Value | Population, setting and year as reported | Source |
|---|---|---|---|
| Injured adolescents who underwent substance use screening | 63.4% | 434 of 683 injured adolescents aged 12 to 17 at a level I pediatric trauma center, January 2021 to June 2024 | [3] |
| Positive screens with a documented referral | 36.4% | 32 of 88 injured adolescents with at least one positive result, same trauma center | [3] |
| Clinicians screening at every well visit with a tool | 39.3% | 411 of 1047 U.S. youth-serving clinicians, national survey, September to October 2023 | [10] |
| Clinicians offering all SBIRT components | 30.7% | 321 of 1047 U.S. youth-serving clinicians, same 2023 survey | [10] |
| Probation youth with substance use-only indicator referred | 27% | Youth in need of treatment at 14 probation sites in three states, March 2014 to November 2017 | [15] |
Continuum of care
Where the continuum breaks between screening and treatment
A positive screen begins a handoff; it does not finish a task. The continuum depends on whether a brief intervention happens, a referral is placed and the young person actually starts care. Each step has a different owner. The evidence shows each step can fail on its own, even when the step before it looks strong. In practice, one discipline may screen, another may deliver the intervention, and a third may place the referral.
In the trauma center cohort, 88 adolescents (20.3% of those screened) had at least one positive result.[3] Only 434 of the 683 injured adolescents were screened at all, so the leak begins before any positive result.[3] Only 32 (36.4%) of the 88 had a documented referral to substance use support services.[3] A nine-center pediatric trauma implementation study found documented screening rose from 16.3% to 65.7%.[12] Brief interventions rose from 27.1% to 40.7% in the same centers.[12] Referral back to primary care for continued discussion stayed low in both record data and adolescent reports.[12]
Juvenile justice settings show a similar pattern. Among 8552 youth on probation identified as needing treatment, 2069 received a referral, and 1630 of those referred initiated treatment.[15] Youth with internalizing, externalizing or both co-occurring indicators were referred at only 16%, 18% and 20%, respectively.[15] Of those referred, 63%, 69% and 57% initiated treatment.[15] Site-level variation was substantial, so local program supply may shape who is referred.[15]
The emergency department is another transition point with its own design choices. One pediatric emergency department combined chief complaint-triggered alerts with provider education, formulary changes and clinical pathways.[2] Among patients with qualifying complaints, naloxone dispensing rose from 3.89% to 11.39%.[2] Buprenorphine prescribing rose from 1.04% to 2.46% in the same group.[2] Visits that triggered the alert ran longer, but return visits did not increase.[2] Over 45 months, 63 adolescents initiated buprenorphine and 246 received naloxone.[2]
For executives, the lesson is that referral needs its own owner and its own measure. Screening rates alone can look healthy while many positive screens never reach a receiving team.[3] Treatment initiation after referral is a separate step that also deserves tracking across partner organizations.[15] A practical test is to follow a sample of recent positive screens and ask where each one ended up.
Figure 3
Why the pathway breaks
People
- Clinicians unsure how to counsel after a positive screen
- No on-site substance use counseling providers
- Lower-volume practices screen less routinely
Process
- Referral step has no named owner
- Referral back to primary care rarely documented
- Intermittent screening rather than every well visit
Technology
- Screener results not recorded in usable form
- No alerts tied to presenting complaints
- No shared status for referrals to outside partners
Environment
- Few outpatient, inpatient and medication options for adolescents
- Waits of more than one day after a healthcare referral
- Transport, cost and time off work for families
Policy
- Consultation programs offer limited substance use pathways
- Programs that cannot treat co-occurring needs
- Uneven practice across regions and sites
Measurement
- Screening counted without referral or treatment start
- Documentation diverges from adolescent experience
- Results not stratified by age, race, insurance or co-occurring needs
Unranked qualitative cause-and-effect diagram for the outcome in the box: Adolescents who screen positive for substance use do not reach and start timely treatment Causes are assembled from the cited literature [8], [3], [12], [14], [2], [4], [13], [5], [15], [10]; categories are not weighted and their order carries no meaning.
Data note. Qualitative; no frequencies are implied.
Limitation. Causes drawn from published studies may not all apply locally; validate them with frontline teams.
Figure data (6 rows)
| Category | Causes drawn from the cited literature |
|---|---|
| People | Clinicians unsure how to counsel after a positive screen; No on-site substance use counseling providers; Lower-volume practices screen less routinely |
| Process | Referral step has no named owner; Referral back to primary care rarely documented; Intermittent screening rather than every well visit |
| Technology | Screener results not recorded in usable form; No alerts tied to presenting complaints; No shared status for referrals to outside partners |
| Environment | Few outpatient, inpatient and medication options for adolescents; Waits of more than one day after a healthcare referral; Transport, cost and time off work for families |
| Policy | Consultation programs offer limited substance use pathways; Programs that cannot treat co-occurring needs; Uneven practice across regions and sites |
| Measurement | Screening counted without referral or treatment start; Documentation diverges from adolescent experience; Results not stratified by age, race, insurance or co-occurring needs |
Access
Making referral destinations reachable for young people
Referral only works when there is somewhere to send a young person. Pediatricians describe that destination as hard to find. In a national survey, 76% found it difficult or very difficult to find outpatient behavioral interventions for adolescent substance use.[8] Most also reported difficulty finding inpatient treatment (79%) or medication management services (73%).[8] These shortages describe the very destinations that a referral order assumes already exist.
Limited treatment options shape whether clinicians screen at all. The most common barrier to screening was a lack of treatment options for adolescents with a positive screen, cited by 69% of pediatricians.[8] A lack of on-site substance use counseling providers was cited by 67%.[8] Treatment capacity and screening reliability therefore belong in the same executive conversation. If clinicians expect no destination, the screen itself can feel like a promise the practice cannot keep.
Even when a request is made, waits are common. National admissions data covered 124,501 adolescents with cannabis use disorder in publicly funded treatment from 2012 to 2022.[4] About 31.0% experienced a delay of more than one day after first requesting care.[4] Delays fell to 26.1% in 2018 but rose again to 33.8% by 2022, when 5.4% waited at least 30 days.[4] Healthcare referrals were associated with greater delays than self-referrals (OR=1.43).[4] That finding points directly at clinical referral routes as a place to improve.
Consultation lines can stretch scarce specialist capacity. A statewide adolescent addiction consultation helpline completed 125 consultations from July 2021 to March 2023.[11] Most callers were health care providers (71%) or parents (27%).[11] About 26% of calls related to an overdose, and 17% of consultations resulted in urgent evaluations.[11] Recommendations included outpatient therapy in 86% of consultations and new medications in 17%.[11] Yet only 58.6% of child psychiatry access programs offered any substance use resource in 2025.[5] Just 22.4% provided substance use clinical pathways, compared with 44.8% for depression.[5]
The wider systems picture is consistent. Adolescents tend to rely on adults to reach treatment, and services seen as adolescent-specific, youth-friendly and flexible encourage attendance.[13] Treatment costs, including time off work and transport, act as barriers for families.[13] The review also calls for clear protocols for the professionals who direct young people toward treatment.[13] Health systems can supply those protocols, transport support and flexible scheduling as one access design.
Executive guidance · System route
Build one visible operating route for Red Ribbon Week.
Use this route as a discussion framework. Replace each stage with the organization’s approved process, qualified roles, current service capacity, and applicable requirements. Do not infer a clinical protocol from the observance title.
The route at a glance
- Listen
- Clarify entry
- Coordinate the partner route
- Protect transitions
- Verify and learn
Reliability rule: Every stage needs a named owner, an observable status, an approved escalation path, and a defined signal that shows whether responsibility moved or remained unresolved.
Listen
Gather questions and friction points from people using the route, frontline teams, and community-facing staff. Separate observed barriers from assumptions.
Clarify entry
Publish a plain-language first step and identify who receives requests through each approved channel.
Coordinate the partner route
Align internal teams and external partners around one current message, real entry point, receiving owner, escalation path, and follow-through signal.
Protect transitions
Use acknowledgment and status visibility when responsibility moves between services, locations, or organizations.
Verify and learn
Review unresolved work, repeat contacts, and avoidable handoffs. Use the findings to improve the route rather than blame individuals.
Figure 2
The system route as one flow
The five stages of the system route described in this brief, drawn as one flow with a learning loop back to the start. The stages are the page’s original executive guidance, not a clinical protocol.
Data note. Shows sequence and handoffs only; it carries no counts or rates.
Limitation. Local processes may add, merge or reorder stages under organizational policy.
Figure data (5 rows)
| Stage | What the stage requires |
|---|---|
| Listen | Gather questions and friction points from people using the route, frontline teams, and community-facing staff. Separate observed barriers from assumptions. |
| Clarify entry | Publish a plain-language first step and identify who receives requests through each approved channel. |
| Coordinate the partner route | Align internal teams and external partners around one current message, real entry point, receiving owner, escalation path, and follow-through signal. |
| Protect transitions | Use acknowledgment and status visibility when responsibility moves between services, locations, or organizations. |
| Verify and learn | Review unresolved work, repeat contacts, and avoidable handoffs. Use the findings to improve the route rather than blame individuals. |
Equity and trust
Equity and trust across the youth substance use pathway
Need far exceeds treatment receipt. A systematic review cites U.S. research showing that 4.1% of 12- to 17-year-olds require treatment, yet fewer than 10% of them access it.[13] The same review found that access appears more difficult for females and socially marginalized youth.[13] Those gaps sit across schools, clinics and community agencies, so no single department can close them alone. A shared equity review across those partners is more useful than separate reports that never meet.
Burden is rising unevenly. Emergency visits for opioid overdose rose most among patients who were male, Black, Hispanic or multiracial, urban and publicly insured.[6] Children aged 0 to 4 years accounted for 45.7% of visits.[6] Rates of intensive care admission also increased over the study period.[6] That figure is a reminder that household and family safety belongs inside the prevention pathway, not beside it.
Delay patterns do not run in one direction. Adolescents aged 12 to 14 years experienced delays more often than those aged 15 to 17 years.[4] White non-Hispanic adolescents had higher odds of delay than Hispanic adolescents (OR=1.29).[4] Leaders should examine their own stratified data rather than assume where gaps sit. Age, sex, race and ethnicity, insurance, referral source and treatment setting are all worth examining together. Co-occurring mental health needs add another layer, because probation youth with those indicators had low referral rates.[15]
Design choices can change who is reached. After the emergency department protocol began, Black or African American adolescents and those with government insurance received more medications than peers.[2] Geography matters too. Compared with the Northeast, pediatricians in the Midwest had an adjusted odds ratio of 0.26 for using a standardized screening instrument.[8] Similar gaps appeared in the South (0.56) and the West (0.46).[8] Regional and site variation is a signal for standard work, not for blaming individual clinicians. The fix is usually a shared tool, a shared workflow and shared feedback on results.
Trust shapes what young people disclose and what records capture. In the nine-center trauma study, adolescents reported being asked about alcohol or drug use more often than records showed, at 80.7% before and 81% after implementation.[12] Implementation was not associated with any change in adolescents’ perceptions of these services.[12] Measures built only on documentation can miss what young people actually experienced. Equity review should also ask whether young people trust that disclosure will be handled with confidentiality and respect.
Human infrastructure
The people who make screening and referral work
Screening and referral are team tasks, not single-clinician tasks. In the nine-center trauma study, the recommended workflow had nursing screen and social work deliver brief intervention and referral.[12] The statewide helpline paired a coordinator with on-call social workers, nurse practitioners, psychiatrists and psychologists.[11] Clear roles let each profession do the part it is trained and staffed to do. When each discipline owns a defined step, the handoff between them becomes visible and measurable.
Clinicians meet this need often. Among youth-serving clinicians, 76.4% reported seeing at least 1 adolescent with a substance use disorder monthly.[10] Most clinicians (60.6%) said skills in substance use disorder diagnosis were relevant to their practice.[10] Those seeing 5 or more per month had higher odds of screening with a standardized tool at every annual well visit (adjusted odds ratio, 2.19).[10] Volume appears to build routine, so lower-volume practices may need more structured support.
Training needs are specific and stated. Half of pediatricians (50%) said they needed more information on counseling.[8] Only 22.4% of child psychiatry access programs offered substance use clinical pathways for primary care.[5] Most programs emphasized screening and gave limited treatment guidance.[5] That leaves frontline clinicians with a screening expectation but thin support for the next step. Embedded behavioral health staff and consultation programs are two ways to fill the counseling gap pediatricians describe. Either option needs a named leader, a budget line and a way to measure whether clinicians actually use it.
Collaborative coaching can build capacity across many sites. The virtual learning collaborative engaged 160 clinicians and paired shorter learning sessions with individualized coaching.[1] Clinics engaged interprofessional team members, identified community resources and increased staff knowledge of guidelines and improvement methods.[1] They also standardized processes and increased use of electronic records and mobile devices in screening.[1] The authors caution that virtual models need close attention to sustaining engagement in busy clinics.[1]
Technology works best when it supports the team. In the 34-site network, monthly screening data were shared with network providers to sustain use of the screener.[14] In the emergency department project, alerts tied to chief complaints prompted providers to complete additional screening.[2] Leaders should budget for staff time to act on those prompts, or the alerts become noise. Monthly feedback costs little and keeps a team’s attention on the measure that matters.
Executive guidance · Operating dashboard
Use a small dashboard to expose friction and ownership.
Do not publish a number until the organization defines its numerator, denominator where relevant, owner, source system, exclusions, review cadence, and limits. The candidates below are management prompts, not benchmarks or reported results.
Four operating signals
Each signal pairs an executive question with one candidate local measure, set out below.
Executive guidance · Signal
Entry-point clarity
Can people and staff identify the approved first step without searching across conflicting instructions?
- Candidate local measure
- Locally defined contact, routing, and repeat-contact signals by channel and service.
Executive guidance · Signal
Ownership reliability
Does a specific team accept each request and make its status visible?
- Candidate local measure
- Requests without an owner, aged work, transfers, and escalations using locally approved definitions.
Executive guidance · Signal
Partner-route reliability
Do participating teams share one current route and understand who owns each dependency?
- Candidate local measure
- Locally defined conflicting instructions, unaccepted handoffs, unresolved dependencies, repeat contacts, and partner feedback.
Executive guidance · Signal
Improvement closure
Does the organization correct recurring friction and report what changed?
- Candidate local measure
- Selected barriers, assigned actions, completion status, and post-change review.
Figure 4
The operating system behind the dashboard
The four operating signals from this brief’s dashboard, each tied to the candidate owner named in the executive scorecard, around one accountable route. Drawn from the page’s original executive guidance.
Data note. Structural diagram; no measured values.
Limitation. Owners are candidates to be confirmed locally.
Figure data (4 rows)
| Operating signal | Candidate owner |
|---|---|
| Entry-point clarity | Executive sponsor and operational lead |
| Ownership reliability | Operational owner and participating teams |
| Partner-route reliability | Sending and receiving owners |
| Improvement closure | Improvement owner and executive sponsor |
Executive guidance · Handoff workflow
Close the loop across teams, settings, and partners.
A handoff is reliable only when the sending party knows who is expected to receive the work, the receiving party acknowledges responsibility, and any unresolved exception remains visible. Local policy and qualified judgment control the actual process.
How responsibility moves
Lane A
From message to accepted ownership
- Confirm the approved message and intended audience.
- Publish the actual entry point and receiving role.
- Acknowledge receipt using the locally approved method.
- Escalate when ownership or response remains unclear.
Lane B
From accepted ownership to verified follow-through
- Record the next accountable owner and visible status.
- Name the sending and receiving owners, shared information, current status, and unresolved dependency.
- Keep unresolved work visible across boundaries.
- Confirm closure or document the continuing exception.
Executive guidance · Executive scorecard
Give leaders one view of route reliability and improvement.
The scorecard keeps review focused on decisions. Leaders should set definitions locally, examine variation without overclaiming cause, and pair quantitative signals with the experience of people who use and operate the route.
Who reviews what
- Executive sponsor and operational lead
- Operational owner and participating teams
- Sending and receiving owners
- Improvement owner and executive sponsor
Candidate owners named in the scorecard, confirmed locally.
| Operating signal | Executive question | Candidate owner | Suggested review point |
|---|---|---|---|
| Entry-point clarity | Can people and staff identify the approved first step without searching across conflicting instructions? | Executive sponsor and operational lead | At campaign launch and close |
| Ownership reliability | Does a specific team accept each request and make its status visible? | Operational owner and participating teams | At a locally defined cadence |
| Partner-route reliability | Do participating teams share one current route and understand who owns each dependency? | Sending and receiving owners | At a locally defined cadence |
| Improvement closure | Does the organization correct recurring friction and report what changed? | Improvement owner and executive sponsor | Until action is verified |
Figure 5
Control points for a reliable youth screening-to-treatment pathway
| Control point | Risk if missing | Owner | Evidence of control |
|---|---|---|---|
| Validated screening at every eligible adolescent visit | Intermittent screening misses young people who need support | Ambulatory medical director with pediatric quality lead | Share of eligible adolescent visits with a completed, recorded screen |
| Brief intervention and referral owned after a positive screen | Positive screens never reach a receiving team | Social work or behavioral health manager in each setting | Share of positive screens with documented brief intervention and referral |
| Referral acceptance and treatment start confirmed with partners | Referrals stall or treatment never begins | Behavioral health access lead with partner liaisons | Share of referrals with a confirmed first appointment and time from request to start |
| Consultation and clinical pathways available to frontline clinicians | Clinicians avoid screening when no next step exists | Chief medical officer with behavioral health service line | Consultation volume, response time and pathway use |
| Emergency and trauma alerts tied to presenting complaints | High-risk adolescents leave without screening or medication access | Emergency and trauma medical directors | Alert completion and medication provision rates by month |
| Stratified review of screening, referral and delay | Gaps by age, race, insurance or co-occurring needs stay hidden | Health equity officer with quality analytics | Quarterly stratified pathway report reviewed by a board committee |
| Youth and family feedback paired with record measures | Documentation overstates or understates what young people experienced | Patient experience lead | Brief follow-up survey results compared with record data |
Control points derived from the cited evidence [1], [3], [12], [15], [4], [11], [5], [2], [6], [14] and this brief’s executive guidance.
Data note. Each row is a control to verify, not a measured result.
Limitation. Owners and evidence of control must follow local policy and applicable requirements.
Public communication
Communicating prevention in ways young people and families trust
Red Ribbon Week messages reach students, parents and school staff at once. The evidence favors trusted messengers in familiar settings. In the peer-led school program, 71.3% of raters viewed it favorably.[9] Some 76.3% named presenters’ personal recovery stories as the most valuable element.[9] The effect on intent was stronger in middle school than high school students (60.3% vs. 49.5%).[9] Recovery stories carried weight because they came from people with lived experience rather than from institutions.
Timing matters as much as the messenger. Of the surveyed students, 27.3% reported ever using substances, and 55.2% reported starting use between ages 14 and 16.[9] Another 29.2% started at an earlier age.[9] Messages for middle school audiences therefore deserve as much planning as high school events, and health system partners can help schools plan both. Pediatric practices can reinforce the same messages at well visits for younger adolescents.
Families are a communication channel in their own right. The family-meals intervention gave parents a handbook, two interventionist meetings and text messages.[7] At 3 months, intervention parents were more likely to report nine of 10 targeted communication items than controls.[7] Children’s reports reached significance on three of 10 items.[7] Some effects remained significant at 6 and 12 months.[7] At 18 months, effects persisted for parent-reported conversations about drinking alcohol.[7] No significant moderation by grade, race and ethnicity, or session type was observed.[7]
Communication also happens inside care, during the screening conversation. Adolescents reported being asked about substance use more often than records documented, so record data alone can understate contact.[12] Pairing documentation measures with brief youth and family feedback gives leaders a truer picture of how the conversation is received. Staff should be able to explain, in plain language, what happens to a young person’s answers.
Every public message should point to a real next step. Parents made 27% of calls to the statewide consultation helpline, suggesting that families will use a clear entry point when one exists.[11] Campaign materials should match the referral routes and consultation resources that are actually staffed locally. Schools, pediatric practices and emergency departments can share one plain-language description of how to reach help. A message that promises help the system cannot deliver erodes the trust that prevention depends on. Reporting back to the community on what changed after the observance is part of keeping that trust.
Executive guidance · 90-day plan
Turn the observance into one sustained operating change.
The time boxes below are a management framework, not a clinical timeline. Adjust them to risk, scope, governance, resources, stakeholder participation, and applicable review requirements.
Ninety days, three moves
- Days 1–30See the current route
- Days 31–60Build the reliable path
- Days 61–90Make the change visible
Days 1–30 · Listen and map
See the current route
- Name an executive sponsor and an operational owner.
- Listen to people using the route and representative frontline teams.
- Map how Red Ribbon Week communications connect to real entry points, owners, transitions, and escalation.
- Select one recurring barrier that the organization can responsibly address.
Days 31–60 · Design and test
Build the reliable path
- Define the trigger, receiving owner, required information, acknowledgment, escalation, and closure signal.
- Validate the design with every sending and receiving team involved.
- Test one internal or partner handoff and correct a verified communication, dependency, or ownership gap.
- Test the route in more than one representative setting or operating period where practical.
Days 61–90 · Implement and verify
Make the change visible
- Launch the redesigned route with a small set of locally defined measures.
- Review unresolved work and recurring friction using a learning approach.
- Correct implementation barriers and record who owns each remaining dependency.
- Report what changed, what evidence was reviewed, and what still requires live oversight.
Figure 6
The 90-day plan on one timeline
The 90-day plan from this brief drawn as a timeline: each action sits in the 30-day window the plan assigns it. The full wording of each action is in the figure data and in the plan above.
Data note. Time boxes are a management framework, not a clinical timeline.
Limitation. Durations are uniform 30-day windows; real tasks may span windows.
Figure data (12 rows)
| Window | Action |
|---|---|
| Days 1–30 · Listen and map | Name an executive sponsor and an operational owner. |
| Days 1–30 · Listen and map | Listen to people using the route and representative frontline teams. |
| Days 1–30 · Listen and map | Map how Red Ribbon Week communications connect to real entry points, owners, transitions, and escalation. |
| Days 1–30 · Listen and map | Select one recurring barrier that the organization can responsibly address. |
| Days 31–60 · Design and test | Define the trigger, receiving owner, required information, acknowledgment, escalation, and closure signal. |
| Days 31–60 · Design and test | Validate the design with every sending and receiving team involved. |
| Days 31–60 · Design and test | Test one internal or partner handoff and correct a verified communication, dependency, or ownership gap. |
| Days 31–60 · Design and test | Test the route in more than one representative setting or operating period where practical. |
| Days 61–90 · Implement and verify | Launch the redesigned route with a small set of locally defined measures. |
| Days 61–90 · Implement and verify | Review unresolved work and recurring friction using a learning approach. |
| Days 61–90 · Implement and verify | Correct implementation barriers and record who owns each remaining dependency. |
| Days 61–90 · Implement and verify | Report what changed, what evidence was reviewed, and what still requires live oversight. |
Executive guidance · Leadership close
Make Red Ribbon Week a starting point, not an endpoint.
Recognition matters. It becomes durable when leaders also listen, clarify the route, support the people operating it, close an identified gap, and report the result without claiming more than the evidence supports.
Leadership commitment
Make ownership visible, test the route, and report what improved.
Executive action kit · Week observance
Turn Red Ribbon Week into accountable action.
A practical executive framework for access, ownership, handoffs, measurement, and improvement.
Leadership focus
Use this observance to examine trustworthy information, prevention access, and community connection. Select one verified barrier, assign an accountable owner, and carry the improvement beyond the campaign window.
Workforce lens
Ask whether staffing, role clarity, training, tools, workload, and escalation support the people operating the information, access, coordination, and follow-through pathway.
Patient and community lens
Make the approved first step clear. Test whether a person can move from information to an acknowledged next action without navigating conflicting instructions.
Equity and access lens
Review language, disability, transportation, digital access, geography, trust, and other barriers using protected feedback and locally appropriate data.
Five-minute briefing
Inspect the operating sequence
Listen with people using the pathway, frontline teams, operational leaders, and community partners. Find one a message, request, referral, or handoff that does not reach an accountable owner, then test the locally approved route from entry through acknowledged follow-through.
- Listen
- Clarify entry
- Coordinate the partner route
- Protect transitions
- Verify and learn
Leadership actions for this week
- Name an executive sponsor and frontline operating owner.
- Ask people using and operating the pathway where ownership becomes unclear.
- Test one representative route from first question to acknowledged next step.
- Select one barrier that can be corrected without overstating the evidence.
- Set a review date and define how completion will be verified.
Candidate measures
Define every numerator, denominator where relevant, owner, data source, exclusions, cadence, and limitation locally. These are management prompts, not external benchmarks.
- Locally defined contact, routing, and repeat-contact signals by channel and service.
- Requests without an owner, aged work, transfers, and escalations using locally approved definitions.
- Locally defined conflicting instructions, unaccepted handoffs, unresolved dependencies, repeat contacts, and partner feedback.
Department readiness checklist
- The public and staff entry points match the actual approved process.
- A specific role accepts each request, referral, or escalation.
- Handoffs include acknowledgment and a visible unresolved state.
- Language, disability, digital, transportation, and trust barriers receive explicit review.
- Communications do not introduce unsupported themes, statistics, or clinical advice.
- A named leader will review what changed after the observance.
Intended audiences
- Executive and Operational Leaders
- Public Health and Community Partners
Staff communication template
During Red Ribbon Week, our organization will connect awareness with a practical review of the information, access, coordination, and follow-through pathway. Use approved information, identify the correct entry point, confirm ownership when work moves, protect privacy, and escalate unresolved barriers through local channels.
Community communication template
Red Ribbon Week is an opportunity to share trustworthy information and make the next step easier to find. Use our approved channels for information and support. If a request changes hands, our goal is to keep ownership and follow-through visible.
Measurement worksheet
- Signal
- What observable condition will show whether the route works?
- Definition
- What is included, excluded, and counted?
- Owner
- Who reviews the signal and acts on exceptions?
- Cadence
- When will leaders review it?
- Equity check
- Which differences require protected, locally appropriate review?
- Closure
- What evidence will confirm the improvement was completed?
- Editorial review
- Completed
- Source records
- 2 listed under Authoritative resources
- Review standard
- Sourced facts remain separated from original executive guidance
- Clinical boundary
- No new statistical or clinical claim was added by this action kit
Sources and content boundary
Authoritative resources
Use note: All operating models, measures, scorecard questions, and action steps are original executive guidance. This article supports leadership planning and education. It does not replace clinical judgment, emergency procedures, legal advice, professional standards, organizational policy, or applicable federal, state, and local requirements.
Peer-reviewed references
References
Fifteen peer-reviewed sources, newest first. Each was individually verified through authenticated academic research databases. Bracketed numbers in the text link here; the original executive guidance on this page carries no citations because it is guidance, not a sourced claim. Sources last checked in those databases on .
- 1.Shaikh U, Correa AB, Monti J, Rahmandar MH, Courtlandt C. Improving Screening for Adolescent Substance Use and Mental Health in Primary Care. American Journal of Medical Quality. 2026. https://doi.org/10.1097/jmq.0000000000000337
- 2.Buresh C, Kaplan R, Lowry S, Sandelich S, Rutman L. Improving Naloxone and Buprenorphine Provision in the Pediatric Emergency Department Through Education and Chief Complaint-Triggered Screening. Pediatric Emergency Care. 2026. https://doi.org/10.1097/pec.0000000000003640
- 3.Lee JS, Spurrier RG, Ourshalimian S, Rook JM, Barq R, Otaibi B, et al. Factors associated with referrals after substance use screening in adolescent trauma patients. Journal of Pediatric Surgery. 2026:163461. https://doi.org/10.1016/j.jpedsurg.2026.163461
- 4.Kitsantas P, Kunz-Lomelin A, Xue H, Kornides ML. Admission Delays in Receiving Treatment for Cannabis Use Disorder Among U.S. Adolescents. American Journal of Preventive Medicine. 2026;71(3):108361. https://doi.org/10.1016/j.amepre.2026.108361
- 5.Ball A, Lee CM, Tripp P, Sarvet B, Congdon J. Substance Use Services at Child Psychiatry Access Programs. Journal of Adolescent Health. 2026;79(2):282-285. https://doi.org/10.1016/j.jadohealth.2026.03.003
- 6.Devlin G, Kanak M, Hall M, Tanaka D, Bohorquez J, Gribbons M, et al. Pediatric Emergency Department Visits for Opioid Overdose in the United States. Hospital Pediatrics. 2026;16(2):143-150. https://doi.org/10.1542/hpeds.2025-008620
- 7.Skeer MR, Eliasziw M, Sabelli RA, Hajinazarian G, Ryan EC, Lee-Bravatti MA, et al. Parent-Child Communication Results From an Efficacy Trial of a Brief Family-Based Adolescent Substance Use Preventive Intervention. Journal of Adolescent Health. 2025;77(6):1097-1107. https://doi.org/10.1016/j.jadohealth.2025.08.005
- 8.Camenga DR, Hadland SE, Somberg C, Burr W. U.S. Pediatricians’ Attitudes and Practices Around Screening for Substance Use in Adolescents. Journal of Adolescent Health. 2025;77(3):499-506. https://doi.org/10.1016/j.jadohealth.2025.04.024
- 9.Verbos II KW, Agolli A, Sandelich S, Alvarado A, Jusufagic A, Croes KD, et al. “Ignite & engage:” A mixed methods evaluation of a peer-led, school-based substance use prevention program. Addiction Science & Clinical Practice. 2025;20(1):65. https://doi.org/10.1186/s13722-025-00595-6
- 10.Ragan-Burnett K, Schieber L, Terranella A, Mikosz C. Substance Use Screening, Brief Intervention, and Referral to Treatment Among Youth-Serving Clinicians. JAMA Network Open. 2025;8(5):e2511579. https://doi.org/10.1001/jamanetworkopen.2025.11579
- 11.Adams ZW, Smoker MP, Marriott BR, Mermelstein SP, Ojo O, Aalsma MC, et al. A Statewide Consultation Helpline for Rapid Linkage to Services for Youths With Opioid Use Disorder and Other Substance Use. Psychiatric Services. 2024;75(10):979-985. https://doi.org/10.1176/appi.ps.20230289
- 12.Mello MJ, Baird J, Spirito A, Scott K, Zonfrillo MR, Lee LK, et al. Adolescents’ Perceptions of Screening, Brief Intervention, and Referral to Treatment Service at Pediatric Trauma Centers. Substance Use: Research and Treatment. 2024;18:29768357241272356. https://doi.org/10.1177/29768357241272356
- 13.James PD, Nash M, Comiskey CM. Barriers and Enablers for Adolescents Accessing Substance‐Use Treatment: A Systematic Review and Narrative Synthesis. International Journal of Mental Health Nursing. 2024;33(6):1687-1710. https://doi.org/10.1111/inm.13378
- 14.Karas D, Eggleston L, Goldman W, Bigham M, White PC. Substance Use Screening in a Large Pediatric Primary Care Network: A Quality Improvement Project. Pediatric Quality & Safety. 2024;9(4):e745. https://doi.org/10.1097/pq9.0000000000000745
- 15.Stanley JN, DeLucca SC, Perron L, Belenko S. The impact of co-occurring mental health problems on referral to and initiation of treatment among youth under probation supervision: Findings from a cluster randomized trial. Journal of Substance Use and Addiction Treatment. 2024;160:209279. https://doi.org/10.1016/j.josat.2023.209279
Claim-to-source matrix
What each source supports
Every sourced claim in the new sections maps to the references that support it, the section where it is used, and the limitation a reader should keep in mind. Original executive guidance carries no sources because it is guidance, not a finding.
| Claim group | Sources | Years | Used in | Limitation |
|---|---|---|---|---|
| Rising youth opioid overdose burden and intentional adolescent overdoses | [6] | 2026 | Current evidence | Administrative data from tertiary-care children’s hospitals, 2017 to 2022; coded diagnoses; nonfatal visits only partly reflect community burden. |
| Inconsistent screening and incomplete SBIRT delivery in primary care | [10] [8] | 2025 | Current evidence | Clinician self-report surveys with response rates of 57% and 43%; practice may differ from report. |
| Quality improvement and learning collaboratives raise screening and follow-up | [1] [14] | 2026, 2024 | Current evidence | Pre-post quality improvement designs without control groups; patient outcomes not reported. |
| School peer-led and family-based prevention | [9] [7] | 2025 | Current evidence | Peer program evaluated by anonymous post-event survey with partial response; family trial measured communication, not substance use outcomes. |
| Low referral after positive screens in trauma and justice settings | [3] [12] [15] | 2026, 2024 | Continuum of care | Single-center retrospective cohort, nine-center implementation study and probation sites in three states; documentation may understate referral. |
| Emergency department alerts and education increase medication provision | [2] | 2026 | Continuum of care | Single pediatric emergency department pre-post design; small absolute changes. |
| Treatment shortages, delays and consultation capacity | [8] [4] [11] [5] | 2026, 2025, 2024 | Access | Survey, admissions and program data from publicly funded or specific settings; delay defined as more than one day from first request. |
| Barriers and enablers to adolescent treatment access | [13] | 2024 | Access | Narrative synthesis of 32 papers, almost all from outside Europe; heterogeneous designs. |
| Disparities in burden, delay and screening practice | [6] [4] [2] [8] [13] | 2026, 2025, 2024 | Equity and trust | Observational associations; subgroup patterns vary by setting and may reflect referral and coding differences. |
| Adolescent experience versus documented screening | [12] | 2024 | Equity and trust | 30-day adolescent survey with incomplete follow-up; recall may be imperfect. |
| Team roles, training needs and clinician volume | [12] [11] [10] [8] [5] [1] | 2026, 2025, 2024 | Human infrastructure | Descriptive program and survey data; no workforce outcome measures. |
| Trusted messengers, early timing and family communication | [9] [7] [11] | 2025, 2024 | Public communication | Self-reported intent and communication; no measured change in substance use. |
About the author
Greg Wahlstrom
MBAHCM
President and Chief Executive Officer, The Healthcare Executive
View Greg’s profile©2014 – 2026 The Healthcare Executive. All rights reserved.