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Exploring barriers and enablers to implementing a digital mental health crisis risk mitigation pathway in acute
Takawira C Marufu1,2, Jane Coad3,4, Zaki Albelbisi1
1Nottingham Children Hospital, Family Health Clinical Care Group, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Insights
Implementing digital decision support for children and young people in mental health crisis requires aligning digital readiness with clinical safety. Key factors include infrastructure, training, communication, governance, and workforce support for successful integration in acute pediatric settings.
Area of Science:
- Digital Health Interventions
- Clinical Decision Support Systems
- Paediatric Mental Healthcare
Background:
- Children and young people (CYP) in mental health crisis present challenges in acute pediatric settings.
- Existing physical healthcare environments lack tailored digital tools for risk mitigation and decision-making.
- A prototype digital risk mitigation pathway was co-developed as a clinical decision support system.
Purpose of the Study:
- To examine the feasibility of implementing a digital risk mitigation pathway in diverse acute pediatric hospital contexts.
- To identify organizational and workforce determinants influencing the implementation of digital decision support for CYP in crisis.
Main Methods:
- A multi-site, exploratory mixed-methods study using a multiple case study design.
- Data collected via organizational surveys, document analysis, interviews, and focus groups across three hospitals.
- Inductive analysis of qualitative data with within-case and cross-case synthesis.
Main Results:
- Five key implementation determinants identified: digital infrastructure, ICT training/support, communication, information governance, and healthcare professional attributes.
- Significant variation in digital maturity across sites.
- Feasibility depended on aligning digital readiness with clinical safety, device availability, workflow integration, governance, and workforce support.
Conclusions:
- Novel, contextually grounded insights into organizational and workforce factors for digital decision support implementation in acute pediatric care.
- Aligning digital readiness with clinical safety priorities and addressing multi-level challenges are crucial.
- Findings inform the design, deployment, and scaling of responsive digital health interventions for CYP in mental health crisis.
Objective:
Children and young people (CYP) presenting in mental health crisis to acute paediatric settings represent a growing clinical and system-level challenge. These environments, primarily designed for physical healthcare, frequently lack tailored, evidence-based digital tools to support risk mitigation and clinical decision-making in safety-critical situations. In response, we co-developed a prototype digital risk mitigation pathway, designed as a clinical decision support system, to enhance safety and care quality for CYP in crisis. This study examined the feasibility of implementing this pathway across diverse general hospital contexts.
Methods:
We conducted a multi-site, exploratory mixed-methods study using a multiple case study design across three acute paediatric hospitals in England. Data were collected between October 2022 and March 2023 through organisational surveys, documentary analysis, semi-structured interviews and focus groups. Qualitative data were analysed inductively, with within-case analysis followed by cross-case synthesis to identify patterns of barriers and enablers influencing implementation feasibility.
Results:
Three organisational surveys were completed, 13 organisational documents analysed, and 30 healthcare professionals participated in interviews and focus groups. Five overarching themes were identified as key determinants of implementation: digital infrastructure; information and communications technology training and support; communication; information governance; and healthcare professional attributes. Marked variation in digital maturity was observed across sites. Feasibility was strongly shaped by the alignment of digital readiness with clinical safety requirements, device availability, workflow integration, governance processes and workforce support in time-pressured crisis care.
Conclusion:
This study provides novel, contextually grounded insights into the organisational and workforce determinants shaping the feasibility of implementing digital decision support in acute paediatric care. Our findings highlight the central importance of aligning digital readiness with clinical safety priorities and addressing multi-level implementation challenges. These insights offer actionable evidence to inform the design, deployment and scaling of contextually responsive digital health interventions for CYP admitted in mental health crisis.
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