Several major policy reports describe the central role of primary care in improving the delivery of behavioral health care services to children and adolescents. Although primary care providers are uniquely positioned to provide these services, numerous obstacles hinder the integration of these services, including time, clinic management and organization issues, training, and resources. Although many of these obstacles have been described in the literature, few studies have investigated these issues from the first-person perspective of front-line providers. The purpose of this study, therefore, is to provide an in-depth description of primary care providers' attitudes and perceptions of adolescent behavioral health care across a diversity of primary care settings (i.e., Federally Qualified Health Center [FQHC], FQHC-Look Alike, school-based, military). Sixteen focus groups were conducted at 5 primary care clinics. Thematic analysis was used to analyze the focus group data. Obstacles to integration are presented as well as strategies to overcome these challenges, using training and education, working groups, and community collaboratives.

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Over a three-year period, 29 adolescent patients were hospitalized because of intentional Jimson weed ingestion. Their records were reviewed for the presence of signs and symptoms of atropine/scopolamine toxicity, clinical course, treatment, and outcome. Twentytwo were male and seven were female. All had mydriasis, hallucinations, and were disoriented. Tachycardia (heart rate >95), dry mucous membranes, and flushed facies were often present. Urinary retention requiring catheterization was present in five patients. Sixty-five percent (17/26) had detectable atropine or scopolamine in their urine. The average length of hospitalization was 1.8 days. No serious complications were encountered during hospitalization and full recovery was noted in all patients. Gastric lavage and hospital admission for close monitoring and medical support are essential phases of management. Physicians who care for adolescents should be aware of this relatively new form of drug abuse and its management.

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