Abstract：
OBJECTIVE: Pediatric primary care (PPC) is a common treatment site for pediatric mental health, but it is currently unable to meet the needs of all teen patients, particularly those with minoritized identities and/or marginalized experiences. Digital mental health (DMH) low-intensity treatments (LITs) can increase mental health screening and care capacity in PPC, but how this is done successfully without burdening providers, patients, or families is unclear. This paper presents a pre-implementation study aimed at understanding the implementation context (PPCs in Chicago, IL) for a specific DMH LIT.
METHODS: Using a mixed-methods design, quantitative data from an online survey of providers assessed current DMH practices in PPC, and qualitative interviews with Pediatricians and Pediatric Psychologists examined implementation determinants for a specific DMH LIT. Quantitative data were analyzed using descriptive statistics, and interviews were analyzed using rapid qualitative assessment.
RESULTS: Survey reports (n = 105) and interviews (n = 6) indicated low current use of DMH. Providers in PPC clinics voiced multiple reasons for low usage and low perceived feasibility, including: Consolidated Framework for Implementation Research (CFIR) Inner Setting Domain (PPC clinic workflow, responsibility and ethical considerations, patient privacy and confidentiality), CFIR Outer Setting Domain (hospital and healthcare system factors), CFIR Innovation Domain (DMH design), and a cross-cutting theme of safety.
CONCLUSIONS: Provider-reported low feasibility for integrating DMH in PPC is a call to action to partner with interdisciplinary colleagues and identify how such settings can ethically and seamlessly deliver digital evidence-based and accessible screening and care prior to implementation.
METHODS: Using a mixed-methods design, quantitative data from an online survey of providers assessed current DMH practices in PPC, and qualitative interviews with Pediatricians and Pediatric Psychologists examined implementation determinants for a specific DMH LIT. Quantitative data were analyzed using descriptive statistics, and interviews were analyzed using rapid qualitative assessment.
RESULTS: Survey reports (n = 105) and interviews (n = 6) indicated low current use of DMH. Providers in PPC clinics voiced multiple reasons for low usage and low perceived feasibility, including: Consolidated Framework for Implementation Research (CFIR) Inner Setting Domain (PPC clinic workflow, responsibility and ethical considerations, patient privacy and confidentiality), CFIR Outer Setting Domain (hospital and healthcare system factors), CFIR Innovation Domain (DMH design), and a cross-cutting theme of safety.
CONCLUSIONS: Provider-reported low feasibility for integrating DMH in PPC is a call to action to partner with interdisciplinary colleagues and identify how such settings can ethically and seamlessly deliver digital evidence-based and accessible screening and care prior to implementation.
摘要：
目的：儿科初级保健（PPC）是儿科心理健康的常见治疗场所，但它目前无法满足所有青少年患者的需求，特别是那些具有minorized身份和/或边缘化经历的人。数字心理健康（DMH）低强度治疗（LIT）可以提高PPC的心理健康筛查和护理能力，但是如何在不给提供商带来负担的情况下成功完成这项工作，病人,或者家庭不清楚。本文提出了一项实施前研究，旨在了解实施上下文(芝加哥的PPC，IL)用于特定的DMHLIT。
方法：使用混合方法设计，来自提供商在线调查的定量数据评估了PPC中当前的DMH实践，与儿科医生和儿科心理学家的定性访谈检查了特定DMHLIT的实施决定因素。定量数据采用描述性统计分析，和访谈使用快速定性评估进行分析。
结果：调查报告（n=105）和访谈（n=6）表明目前DMH的使用量较低。PPC诊所的提供商表达了低使用率和低可行性的多种原因，包括：实施研究综合框架(CFIR)内部设置域(PPC诊所工作流，责任和道德考虑，患者隐私和保密)，CFIR外部设置域(医院和医疗保健系统因素)，CFIR创新领域（DMH设计），和安全的交叉主题。
结论：提供者报告的将DMH整合到PPC中的可行性较低，这是与跨学科同事合作的行动呼吁，并确定此类设置如何在实施之前在道德上和无缝地提供基于数字证据和可访问的筛查和护理。
方法：使用混合方法设计，来自提供商在线调查的定量数据评估了PPC中当前的DMH实践，与儿科医生和儿科心理学家的定性访谈检查了特定DMHLIT的实施决定因素。定量数据采用描述性统计分析，和访谈使用快速定性评估进行分析。
结果：调查报告（n=105）和访谈（n=6）表明目前DMH的使用量较低。PPC诊所的提供商表达了低使用率和低可行性的多种原因，包括：实施研究综合框架(CFIR)内部设置域(PPC诊所工作流，责任和道德考虑，患者隐私和保密)，CFIR外部设置域(医院和医疗保健系统因素)，CFIR创新领域（DMH设计），和安全的交叉主题。
结论：提供者报告的将DMH整合到PPC中的可行性较低，这是与跨学科同事合作的行动呼吁，并确定此类设置如何在实施之前在道德上和无缝地提供基于数字证据和可访问的筛查和护理。
