"Technology is Amazing… But Right Now, I Just Don't Know": Real-world Implementation Experiences and Adaptation...

Mobile messaging interventions can improve engagement and support functional recovery among people with serious mental illness, yet they are seldom implemented in real-world community mental health settings. As part of a randomized controlled trial of a recovery-oriented messaging intervention, community-based clinicians were trained to serve as messaging mobile interventionists. In this qualitative study, we examined their perspectives on barriers, facilitators, and adaptations needed to optimize the acceptability and sustainability of messaging-based care. Semi-structured interviews were conducted with all clinicians (N = 6) who delivered the intervention to 39 clients across two community mental health agencies. Interviews were analyzed using a mixed deductive and inductive thematic approach. Four domains captured clinician perspectives: (1) perceptions of training, supervision, and workflow; (2) benefits for client care and service delivery; (3) challenges to intervention success; and (4) suggested adaptations for intervention design and implementation. Clinicians reported that messaging supported engagement, improved therapeutic relationships, and enhanced individualized care, particularly for clients with depression or social anxiety. They described substantial challenges integrating messaging into daily routines, navigating the technology platform, and adapting clinical skills to a text-based format, especially with clients experiencing cognitive disorganization or symptom-driven communication difficulties. Clinicians recommended clearer role definitions, specific functionality improvements, additional training resources, streamlined goal-setting processes, and flexibility to use synchronous communication when needed. Findings provide concrete guidance for developing improved messaging interventions and strengthening their implementation in community mental health settings based on real-world implementation experiences.