How can pediatric clinics, community health centers, and school-based health centers identify and address youth substance use? In partnership with the Conrad N. Hilton Foundation’s Youth Substance Use Prevention and Early Intervention Strategic Initiative, Abt explored how integrating adolescent substance use screening, brief intervention, and referral to treatment (SBIRT) into such primary care settings can help. Three systemic challenges associated with implementing SBIRT in pediatric primary care settings emerged, and grantees have since identified promising solutions to each.