An evaluation of primary care e-screening for mental health among Te Tai Tokerau youth

Abstract

Introduction: Early detection of, and timely intervention for, mental health and risk behaviours can significantly improve youth health outcomes. YouthCHAT is a user-friendly, time efficient, and culturally safe screening tool for early detection of youth psychosocial issues. With a validated, non-modifiable core, adaptable elements of YouthCHAT allow tailoring to specific contextual needs. Aims: This study aimed to use an implementation science approach in the implementation and process evaluation of YouthCHAT in primary care settings in Te Tai Tokerau (Northland), Aotearoa (New Zealand).Objectives included the evaluation of youth and provider acceptability and feasibility of implementation of YouthCHAT, and identification of the enablers and barriers to its implementation, to create a comprehensive framework for a wider scale rollout. Method: This is a three phase, three-year iterative, mixed-methods, bicultural study, using a co-design approach and conducted in partnership with Māori. Based on the Māori metaphor “he awa whiria” (braided river) to describe combining the strengths of two distinct worldviews into a “workable whole,” a bicultural research framework was created. Data from each phase were used to evaluate the feasibility and acceptability of YouthCHAT and assess the implementation processes. Findings: Complex interventions must be acceptable and feasible for users to be successfully implemented into practice. Usage barriers need to be identified early in the process, and guidelines to integrating the intervention into workflow provided. Communication with both top-down and bottom-up messaging and clinical champions (organic not appointed), are key. Involving end users in the development of the intervention is empowering and provides a sense of ownership. Conclusion: YouthCHAT is a user-friendly, time efficient, and culturally safe screening tool for the early detection of psychosocial issues in New Zealand youth. However, it cannot do so if it is not used in practice. The Consolidated Framework for Implementation Research has been expanded into a model which directs feasible, acceptable, and culturally relevant implementation of YouthCHAT, tailored to context while maintaining the integrity of the tool.