Staff identify practical barriers before measurement-based care rollout in Alberta youth mental health

Staff at an Alberta child and adolescent mental health program generally supported introducing measurement-based care, but a pre-implementation assessment identified unresolved issues involving clinical workflow, staff responsibilities and measure-specific training. The mixed-methods study examined readiness at the Children’s Day Treatment Program, or CDTP, within Alberta Children’s Hospital. Thirteen clinic staff participated; 10 completed a readiness survey and all 13 took part in semi-structured interviews.

Rather than evaluating whether measurement-based care improves patient outcomes, the research assessed readiness, barriers, facilitators and implementation strategies before the planned rollout. Measurement-based care uses patient-reported outcome measures to monitor symptoms and functioning routinely and support clinical decision-making. In the assessment, staff viewed the approach positively and considered it consistent with the program’s emphasis on evidence-based care and monitoring patient progress.

Those findings suggested a favorable starting point for implementation. They did not, however, resolve how patient-reported measures would be incorporated into existing routines, who would administer them, or what preparation staff would require. The study therefore distinguished general acceptance of measurement-based care from readiness to put it into routine practice.

Researchers analyzed the interviews using version 2.0 of the Consolidated Framework for Implementation Research, known as CFIR 2.0, to organize information about implementation conditions. They then mapped the barriers identified by staff to the Capability, Opportunity, Motivation–Behaviour framework, or COM-B. The two frameworks served different but complementary purposes: CFIR structured the coding of interview findings, while COM-B connected those findings to proposed implementation strategies. This process produced a locally grounded plan intended to address the concerns reported by CDTP personnel rather than apply a generic rollout model.

Three practical barriers stood out. Integrating measurement-based care into the program’s existing workflow required attention, including clarification of how the measures would be administered within routine operations. Staff also sought clearer definition of their responsibilities for administering the measures and organizing the associated tasks.

Based on these findings, the research team developed strategies intended to support integration of measurement-based care into the CDTP workflow and resources. The authors reported that implementation would commence using the strategies and would be monitored and modified as needed. That future phase was not part of the pre-implementation assessment reported here, so the study did not measure staff behavior after adoption, how the measures influenced treatment decisions, or effects on patient symptoms, functioning or service use.

It also involved one program and 13 staff members, limiting generalization to clinics with different resources, workflows or organizational structures. The central finding was therefore about implementation readiness: CDTP staff supported measurement-based care in principle, while identifying workflow design, responsibility allocation and targeted training as issues to address before routine use.

Subject of Research: Pre-implementation readiness, barriers and strategies for measurement-based care in an Alberta child and adolescent mental health program

Article Title: Preparing for measurement-based care in child and adolescent mental health: a mixed-methods pre-implementation assessment of barriers, facilitators, and implementation strategies

Article References: Adam, S., Ahmed, S., Cepoiu-Martin, M., Aghabayli, F., Zwicker, J., Dimitropoulos, G., McCabe, E., Arnold, P., Clements, R., & Santana, M. J. (2026). Preparing for Measurement-Based Care in Child and Adolescent Mental Health: A Mixed-Methods Pre-Implementation Assessment of Barriers, Facilitators, and Implementation Strategies. Frontiers in Health Services, 6, 1984498. https://doi.org/10.3389/frhs.2026.1984498

Image Credits: AI Generated

DOI: 10.3389/frhs.2026.1984498

Keywords: measurement-based care, child mental health, adolescent mental health, patient-reported outcomes, implementation readiness, clinical workflow, staff training, mixed-methods research, Alberta, health services research, Preparing, measurement-based