Perceived Facilitators of and Barriers to Implementation of a Decision Support Tool for Adolescent Depression and Suicidality Screening: Focus Group and Interview Study

Abstract

Background Screening Wizard (SW) is a technology-based decision support tool aimed at guiding primary care providers (PCPs) to respond to depression and suicidality screens in adolescents. Separate screens assess adolescents’ and parents’ reports on mental health symptoms, treatment preferences, and potential treatment barriers. A detailed summary is provided to PCPs, also identifying adolescent-parent discrepancies. The goal of SW is to enhance decision-making to increase the utilization of evidence-based treatments. Objective This qualitative study aims to describe multi-stakeholder perspectives of adolescents, parents, and providers to understand the potential barriers to the implementation of SW. Methods We interviewed 11 parents and 11 adolescents and conducted two focus groups with 18 health care providers (PCPs, nurses, therapists, and staff) across 2 pediatric practices. Participants described previous experiences with screening for depression and were shown a mock-up of SW and asked for feedback. Interviews and focus groups were transcribed verbatim, and codebooks were inductively developed based on content. Transcripts were double coded, and disagreements were adjudicated to full agreement. Completed coding was used to produce thematic analyses of the interviews and focus groups. Results We identified five main themes across the interviews and focus groups: parents, adolescents, and pediatric PCPs agree that depression screening should occur in pediatric primary care; there is concern that accurate self-disclosure does not always occur during depression screening; SW is viewed as a tool that could facilitate depression screening and that might encourage more honesty in screening responses; parents, adolescents, and providers do not want SW to replace mental health discussions with providers; and providers want to maintain autonomy in treatment decisions. Conclusions We identified that providers, parents, and adolescents are all concerned with current screening practices, mainly regarding inaccurate self-disclosure. They recognized value in SW as a computerized tool that may elicit more honest responses and identify adolescent-parent discrepancies. Surprisingly, providers did not want the SW report to include treatment recommendations, and all groups did not want the SW report to replace conversations with the PCP about depression. Although SW was originally developed as a treatment decision algorithm, this qualitative study has led us to remove this component, and instead, SW focuses on aspects identified as most useful by all groups. We hope that this initial qualitative work will improve the future implementation of SW.

Medical decision‐making for adolescents with depression: A bibliometric study and visualization analysis via CiteSpace

“…Some technology‐based decision support tools or online decision aids for youth depression and evidence‐based instruments providing information about guideline‐consistent treatment options and inviting users (healthcare professionals and clients) to explore client values and preferences related to treatment options have also attracted substantial attention and deserve further studies in the future (Radovic et al . 2021; Simmons et al . 2017).…”

“…Mobile apps and Internet-supported or computerized programmes, which can provide some benefits, including lower costs, more accessibility, convenience, and adaptability, as well as the avoidance of the stigma attached to using traditional mental health services (Andersson et al 2016;Wickersham et al 2022). Some technologybased decision support tools or online decision aids for youth depression and evidence-based instruments providing information about guideline-consistent treatment options and inviting users (healthcare professionals and clients) to explore client values and preferences related to treatment options have also attracted substantial attention and deserve further studies in the future (Radovic et al 2021;Simmons et al 2017).…”

Shared decision‐making in the treatment of adolescents diagnosed with depression: A cross‐sectional survey of mental health professionals in China

“…Adolescents diagnosed with depression are in a special period of drastic physical and psychological changes, and they are prone to negative attitudes towards treatment because of stigma and impaired self-esteem (Radovic et al, 2021). Thus, without active family participation in medical decision-making and supervision, negative parenting part of SDM, and they play an important role in the practices of SDM in the clinical setting.…”

Stakeholder perspectives on digital behavioral health applications targeting adolescent depression and suicidality: Policymaker, provider, and community insights

“…Adolescent depression and suicidality have increased substantially over the past decade, with 15.7% of persons aged 12–17 experiencing a major depressive episode (Substance Abuse and Mental Health Services Administration, 2020). Primary care is an ideal place to address these issues, given the large numbers of adolescents seen (Rand & Goldstein, 2018) and the increasing role played by primary care providers (PCPs) in delivering behavioral health services (Foy et al, 2019). Currently, one-third of youth receiving outpatient mental healthcare receive care from their PCP alone (Anderson et al, 2015).…”

“…The Center Steering Committee (CSC) establishes scientific priorities, supports annual evaluations, and oversees studies, resources, human protection. The ETUDES Center supports three studies: (a) Screening Wizard, a screening decision support tool to assist providers in making treatment recommendations (Radovic et al, 2021); (b) Text2Connect, an automated text messaging intervention to increase adolescents' motivation to attend mental health appointments (Suffoletto et al, 2021); and (c) BRITE, a personalized safety planning and emotion regulation app onto which providers initially onboard new adolescents (Kennard et al, 2018). The goal is to combine these into an integrated suite of technology interventions for addressing adolescent depression and suicidality in primary care.…”