JMIR Publications

ABSTRACT

Background:

Young adults, aged 15 to 24, are more likely to experience mental health or substance use issues than other age groups. This is a critical period for intervention as mental health disorders, if left unattended, may become chronic, serious, and negatively affect many aspects of a young person’s life. Even among those who are treated, poor outcomes will still occur for a percentage of youth. Electronic mental health tools (eMH) have been implemented in traditional mental health settings to reach youth requiring assistance with mental health and substance use issues. However, the utility of eMH in school settings has yet to be investigated.

Objective:

The objective of this study is to gain an understanding of the perspectives of key school staff stakeholders regarding barriers and facilitators to the implementation of the Innowell eMH platform in secondary schools across Alberta, Canada.

Methods:

Guided by a qualitative descriptive approach, focus groups were conducted to elicit stakeholder perspectives on the perceived implementation challenges and opportunities of embedding the Innowell eMH platform into secondary school mental health services. Eight focus groups were conducted with 52 key school staff stakeholders.

Results:

Themes related to barriers and facilitators for youth and school mental health care professional (MHCP) capacity in implementing and employing eMH were identified. With respect to youth capacity barriers, the following were inductively generated: 1) concerns about some students not being suitable for eMH; 2) minors requiring consent from parents/caregivers to use eMH and confidentiality/privacy concerns; and 3) limited access to technology and/or internet service among youth. A second theme related to school MHCP barriers to implementation include: 1) feeling stretched with high caseloads and change fatigue; 2) concerns with risk and liability; and 3) unmasking mental health issues in the face of limited resources. In contrast to the barriers to youth and MHCP capacity, many facilitators to implementation were discussed. Youth capacity facilitators include: 1) potential for youth to be empowered using eMH; 2) the platform fostering therapeutic relationships with school personnel; and 3) enhancing access to needed services and resources. MHCP facilitators for implementation are: 1) system transformation through flexibility and problem solving; 2) opportunities for collaboration with youth and MHCPs and across different systems; and 3) an opportunity for continuity of services.

Conclusions:

Our findings highlight nuanced school MHCP perspectives that demonstrate critical youth and MHCP capacity concerns, with consideration for organizational factors that may impede or enhance the implementation processes for embedding eMH into a school context. The barriers and facilitators to implementation provide future researchers and decision-makers with challenges and opportunities that could be addressed in the pre-implementation phase. Overall, school MHCPs perceive themselves as having the capacity to embrace implementation of an eMH platform as an opportunity to create ways to reduce barriers to students accessing needed mental health services.