Stiles-Shields C, Gustafson EL, Lim PS, et al. Pre-implementation determinants for digital mental health integration in Chicago pediatric primary care. J Pediatr Psychol. 2024;doi:10.1093/jpepsy/jsae058
Increasing teenager’s access to low-intensity treatment options is essential. One promising avenue to overcome the current barriers to universal depression and anxiety screenings in teenagers is to increase the use of digital mental health interventions. For digital interventions to provide adequate support for teenagers, they must be implemented effectively. This article assessed two pre-implementation aims that sought to inform future implementation efforts of the TeACH (Teen Assess, Check, and Heal) system. TeACH provides brief screening, resources, and psychoeducation for anxiety and depression targeting teenagers in urban environments facing digital and health disparities. This exploratory study assessed the needs and practices of clinics serving teens across the Chicagoland area. In addition, using the CFIR, the authors aimed to illuminate the relevant pre-implementation determinants for the TeACH system, and other similar interventions. One hundred and five providers completed the survey. Most practiced in a general pediatric clinic (n=40, 38.1%) or a pediatric subspecialty (n=28, 26.7%). Over half worked in a hospital/medical center (n=76, 72.4%). Most providers did not currently use digital mental health tools (63.8%) and half had never referred a teen to available digital mental health interventions e.g., “Calm” (45.7%). Given the pace of in-office visits, the waiting room was the highest-ranked place to integrate digital screening and brief interventions (30.5%). The common concern here, as with digital interventions in general, was privacy and safety. These were reported as primary issues or concerns for implementing TeACH across workflow (structural characteristics), the hospital and healthcare system factors (local attitudes, policies, and laws), responsibility and ethical considerations (recipient centeredness), and TeACH design (innovation design). If future implementation of digital mental health interventions, like TeACH are attempted in the West Side of Chicago, extensive pre-implementation and local communication efforts will be needed for success. Specifically, while providers acknowledge the need for increased care and screening, the resulting increase in diagnoses may be more than the currently available resources can accommodate.