Primary care-based screening and recruitment for an adolescent depression prevention trial: Contextual considerations during a youth mental health crisis

• Published in: Implementation Research and Practice
• Main Authors: Knepper, Amanda K, Feinstein, Rebecca T, Sanchez-Flack, Jennifer, Fitzgibbon, Marian, Lefaiver, Cheryl, McHugh, Ashley, Gladstone, Tracy R, Van Voorhees, Benjamin W
• Format: Text
• Language: unknown
• Published: SHARE @ Advocate Health - Midwest 2024
• Subjects: child; youth; family; implementation evaluation; inner context; outer context; depression; prevention; qualitative methods; Advocate Aurora Research Institute; Advocate Pediatric Critical Care Medicine Faculty - Park Ridge; Advocate Neonatal-Perinatal Medicine Faculty - Park Ridge; Pediatric and Adolescent Medicine; Behavioral Health; Family Medicine; Aurora Research Institute
• Online Access: https://institutionalrepository.aah.org/advocategme/630; https://doi.org/10.1177/26334895241246203; https://libkey.io/libraries/1712/10.1177/26334895241246203

Background:Rising rates of adolescent depression in the wake of COVID-19 and a youth mental health crisis highlight the urgent need for accessible mental healthcare and prevention within primary care. Digital mental health interventions (DMHIs) may increase access for underserved populations. However, these interventions are not well studied in adolescents, nor healthcare settings. The purpose of this study was to identify barriers and facilitators to screening and recruitment activities for PATH 2 Purpose (P2P): Primary Care and Community-Based Prevention of Mental Disorders in Adolescents , a multi-site adolescent depression prevention trial comparing two digital prevention programs within four diverse health systems in two U.S. states. Method:This qualitative study is a component of a larger Hybrid Type I trial. We conducted semi-structured key informant interviews with clinical and non-clinical implementers involved with screening and recruitment for the P2P trial. Informed by the Consolidated Framework for Implementation Research (CFIR), interviews were conducted at the midpoint of the trial to identify barriers, facilitators, and needed adaptations, and to gather information on determinants that may affect future implementation. Findings:Respondents perceived the P2P trial as valuable, well aligned with the mission of their health systems. However, several barriers were identified, many of which stemmed from influences outside of the healthcare settings. Universal and site-specific outer setting influences (COVID-19 pandemic, youth mental health crisis, local community conditions) interacted with Inner Setting and Innovation domains to create numerous challenges to the implementation of screening and recruitment. Conclusion:Our findings emphasize the need for ongoing, comprehensive assessment of dynamic inner and outer setting contexts prior to and during implementation of clinical trials, as well as flexibility for adaptation to unique clinical contexts. The CFIR is useful for assessing determinants ...