Clinicians' provision of a self-guided digital mental health intervention to adolescents with depressive symptoms at preventive health visits in California.

Objective: We explored the feasibility of integrating a digital mental health intervention (DMHI) for adolescents identified with mild or moderate depressive symptoms during preventive health encounters. Methods: We conducted a quality improvement study at a large integrated health care system in California from August to December 2023. Collaborators included 47 physicians and a nurse practitioner. Results: Of 1200 health encounters with adolescents, 1143 (95%) documented depression screening. Screening identified depressive symptoms at 106 (9%) encounters, including 41 (3%) with mild to moderate symptoms, 14 (1%) with moderately severe or severe symptoms, and 51 (5%) who screened positive with no information on depression severity. Clinicians documented a DMHI referral offer at 17 encounters with mild to moderate symptoms (41%) and 7 encounters with moderately severe or severe symptoms (50%). Over half of youths with depressive symptoms who were offered the DMHI accepted it (52%), but only one-fifth obtained the download instructions. Clinicians appreciated having a DMHI available, but challenges included difficulty identifying adolescents with depressive symptoms and low adolescent interest. Clinicians recommend facilitating adolescent download of the DMHI at the visit and involving parents/guardians. Conclusions: A clinician-focused implementation strategy demonstrated limited success in integrating DMHI into adolescent preventive health visits.