Background Despite effective psychosocial interventions, gaps in access to care persist for youth and families in need. Behavioral intervention technologies (BITs) that apply psychosocial intervention strategies using technological features represent a modality for targeted prevention that is promising for the transformation of primary care behavioral health by empowering parents to take charge of the behavioral health care of their children. To realize the potential of BITs for parents, research is needed to understand the status quo of parental self-help and parent-provider collaboration to address behavioral health challenges and unmet parental needs that could be addressed by BITs. Objective The aim of this study is to conduct foundational research with parents and health care stakeholders (HCS) to discover current practices and unmet needs related to common behavioral health challenges to inform the design, build, and testing of BITs to address these care gaps within a predominantly rural health system. Methods We conducted a convergent mixed-parallel study within a large, predominantly rural health system in which the BITs will be developed and implemented. We analyzed data from parent surveys (N=385) on current practices and preferences related to behavioral health topics to be addressed in BITs along with focus group data of 48 HCS in 9 clinics regarding internal and external contextual factors contributing to unmet parental needs and current practices. By comparing and relating the findings, we formed interpretations that will inform subsequent BIT development activities. Results Parents frequently endorsed several behavioral health topics, and several topics were relatively more or less frequently endorsed based on the child’s age. The HCS suggested that BITs may connect families with evidence-based guidance sooner and indicated that a web-based platform aligns with how parents already seek behavioral health guidance. Areas of divergence between parents and HCS were related to internalizing problems and cross-cutting issues such as parenting stress, which may be more difficult for health care HCS to detect or address because of the time constraints of routine medical visits. Conclusions These findings provide a rich understanding of the complexity involved in meeting parents’ needs for behavioral health guidance in a primary care setting using BITs. User testing studies for BIT prototypes are needed to successfully design, build, and test effective BITs to empower parents to take charge of promoting the behavioral health of their children.

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BACKGROUND Despite innovations to integrate behavioral health practitioners in primary care settings and online adaptations of effective parenting programs, access to care gaps persist for youth and families in need. Behavioral intervention technologies (BITs) represent a modality for targeted prevention with promise for transforming primary care behavioral health by empowering parents to take charge of their child’s behavioral health care. In order to realize the potential of BITs, research is needed to understand parental needs in a BIT, as well as the status quo of parent self-help and parent-provider collaboration to identify and address behavioral health challenges. OBJECTIVE Engage parents and health care providers to better understand unmet needs and current practices to inform continued development of a BIT for parents to address common behavioral health challenges. METHODS We conducted a convergence validation mixed methods study in which parent quantitative surveys (N=385) on preferences and current practices related to behavioral health themes to be addressed in a BIT were integrated with focus group interview data on internal and external contextual factors contributing to parental unmet needs and current practices with 48 health care stakeholders in 9 child-serving clinics within a large, predominantly rural health system. We integrated these data using joint displays and synthesized areas of confirmation, expansion, and discordance between parents and health care stakeholders. RESULTS Parents frequently endorsed about half of the available themes in their “top 3”, indicating that BITs may not be the preferred modality for all targeted prevention. Additionally, parents also frequently endorsed themes that were not related to child psychopathology (e.g., parenting stress and family communication), indicating parents are interested in guidance on parenting beyond challenging child behavior. Health care stakeholders indicated that an online platform aligns with how parents already seek behavioral health guidance and suggested that a BIT may connect families with evidence-based guidance sooner. We identified areas of convergence related to overt behavior problems (e.g., disruptive behavior, nutrition and eating), and areas of divergence related to internalizing problems and cross-cutting issues that may be more difficult for health care providers to detect. Data integration helped to expand our understanding with regard to factors that may lead to more effective parent-provider partnerships, including the impact of limited time pressure office visits and a deeper understanding of how unmitigated parenting stress interrelates with qualities of parent help-seeking behavior. CONCLUSIONS These findings provide a rich understanding of the complexity involved in meeting parents’ needs for behavioral health guidance in a primary care setting using BITs. Further triangulation of these findings in user testing studies for BIT prototypes is needed to refine our understanding of how to successfully develop and implement an effective BIT to guide parents in taking charge of their child’s behavioral health care. CLINICALTRIAL N/A

Within the UK, it is envisaged that Early Intervention Services will be developed nation‐wide by 2004 and these are expected to adhere to a strict model of service structure and provision. This uniform approach seems to lack the flexibility required to cater for local needs. Therefore, it would appear more appropriate to develop Early Intervention Services based on assessments of first‐episode psychosis (FEP) within the context of the local mental health economy and current service provision. A survey of FEP cases within South and West London revealed that existing mental health services were unable to adequately provide specialist care to this client group. As a result, it was decided to set up a tertiary service to provide comprehensive care to FEP patients based within the community. This package comprises assertive engagement, intensive keyworker support, atypical antipsychotics, psychosocial interventions, specialist psychological treatments, occupational therapy and educational/vocational rehabilitation. An ongoing evaluation of this specially tailored service is being conducted, focussing on patient characteristics, pathways to care, service delivery, patient outcomes and patient, carer and referrer satisfaction.