Prevention of Adolescent Depression in Primary Care: Barriers and Relational Work Solutions

Objective: We sought to understand the factors that affect the ability of healthcare organizations to implement an intervention that involved mental health screening and depression prevention treatment of at-risk adolescents in primary care settings.

Methods: From November 2011 to July 2016 we conducted a study of the implementation of a multisite (N=30) phase 3 randomized clinical trial of an Internet-based depression prevention intervention program (CATCH-IT) and examined the impact of internal barriers to the screening and enrollment process by measuring REACH (the proportion of target audience exposed to the intervention). REACH is a public health measure of engaging population at risk. In addition, written narratives from key study personnel and clinicians were explored to further understand implementation strategies.

Results: Mean REACH values for the study clinics were 0.216 for screening and 0.178 for enrollment to CATCH-IT. Mean REACH enrollment lost due to internal barriers was 0.228. Narratives identified several of these internal obstacles and described the importance of relational work with clinics in overcoming barriers to successfully implement the study.

Conclusions: We developed a Relational Work Model of Implementation that conceptualizes the process of implementing the intervention. It identifies the importance of relational work of study personnel and clinicians in overcoming barriers of implantation and improving REACH.