Preparing for measurement-based care in child and adolescent mental health: a mixed-methods pre-implementation assessment of barriers, facilitators, and implementation strategies

Abstract

Measurement-Based Care (MBC) uses patient-reported outcome measures (PROMs) to routinely monitor patient symptoms and functioning over time and support clinical decision-making. The implementation of MBC in child and adolescent mental health care in Alberta remains sparse, with challenges arising particularly when workflows, staffing, and available resources differ across clinics. This study assessed readiness for MBC implementation at a child and adolescent mental health program and explored the barriers and facilitators that would need to be considered during implementation planning. A mixed-method pre-implementation assessment was conducted at the Children's Day Treatment Program (CDTP) within the Alberta Children's Hospital. Staff at this clinic completed a readiness survey assessing their attitudes towards the implementation of MBC at the CDTP clinic, followed by a semi-structured interview conducted by the research team to explore potential barriers and facilitators to implementation. Data from the survey were summarized using descriptive statistics and data from the interviews were transcribed and coded into the Consolidated Framework for Implementation Research (CFIR) 2.0 framework to assess barriers and facilitators. After this assessment, barriers were then mapped into the Capability, Opportunity, Motivation-Behaviour (COM-B) framework to inform implementation strategies. Thirteen CDTP clinic staff participated in the readiness assessment; ten staff completed the survey and 13 participated in the interview. Staff generally viewed MBC positively and felt that it aligned with the clinic's emphasis on evidence-based care and monitoring patient progress. However, staff also identified potential barriers to implementation, including integrating MBC into the clinic's current workflow, clarifying staff responsibilities for the administration of measures, and providing training on the specific measures being used. These findings were used to inform implementation strategies that address staff concerns and support the integration of MBC into the existing CDTP workflow. The readiness assessment showed that while staff were supportive of MBC, there were also practical issues that needed to be addressed before implementation. Involving clinic staff early helped the research team understand the barriers specific to CDTP and make changes to the implementation strategies based on the clinic's existing workflow and resources. Future stages of the INSIGHT project will assess how well these strategies work in practice and how they support the implementation of MBC.