Scaling up: Facilitators, barriers, and EDI considerations for clinical implementation of a stepped-care early mental health parenting program (I-InTERACT-North)

Tricia S Williams^{1

2}, Angela Deotto¹, Andrea Greenblatt³, Giulia F Fabiano¹, Rivka Green^{1

2}, Janaksha Linga-Easwaran¹, Evdokia Anagnostou^{4

5}, Jennifer Crosbie^{2

6}, Elizabeth Kelley⁷, Steven P Miller⁸, Rob Nicolson^{9

10}, Jennifer Rosart¹¹, Shari L Wade^{12

13}, Melanie Barwick³

Affiliations

¹ Department of Psychology, Neurosciences, & Mental Health, The Hospital for Sick Children, Toronto, Canada.
² Department of Psychiatry, University of Toronto, Toronto, Canada.
³ Child Health Evaluative Services, The Hospital for Sick Children, Toronto, Canada.
⁴ Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada.
⁵ Department of Paediatrics, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.
⁶ Department of Psychiatry, The Hospital for Sick Children Toronto, Canada.
⁷ Department of Psychology and Psychiatry, Queens University, Kingston, Canada.
⁸ Department of Pediatrics, Faculty of Medicine, BC Children's Hospital, Vancouver, Canada.
⁹ Department of Psychiatry, Western University, London, Canada.
¹⁰ Department of Psychiatry, Lawson Health Research Institute, London Health Sciences Centre, London, Canada.
¹¹ University Health Network and Dalla Lanna School of Public Health, Toronto, Canada.
¹² Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
¹³ Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.

PMID: 40548260
PMCID: PMC12179477
DOI: 10.1177/26334895251346816

Scaling up: Facilitators, barriers, and EDI considerations for clinical implementation of a stepped-care early mental health parenting program (I-InTERACT-North)

Tricia S Williams et al. Implement Res Pract. 2025.

. 2025 Jun 19:6:26334895251346816.

doi: 10.1177/26334895251346816. eCollection 2025 Jan-Dec.

Authors

Affiliations

¹ Department of Psychology, Neurosciences, & Mental Health, The Hospital for Sick Children, Toronto, Canada.
² Department of Psychiatry, University of Toronto, Toronto, Canada.
³ Child Health Evaluative Services, The Hospital for Sick Children, Toronto, Canada.
⁴ Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada.
⁵ Department of Paediatrics, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.
⁶ Department of Psychiatry, The Hospital for Sick Children Toronto, Canada.
⁷ Department of Psychology and Psychiatry, Queens University, Kingston, Canada.
⁸ Department of Pediatrics, Faculty of Medicine, BC Children's Hospital, Vancouver, Canada.
⁹ Department of Psychiatry, Western University, London, Canada.
¹⁰ Department of Psychiatry, Lawson Health Research Institute, London Health Sciences Centre, London, Canada.
¹¹ University Health Network and Dalla Lanna School of Public Health, Toronto, Canada.
¹² Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
¹³ Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.

PMID: 40548260
PMCID: PMC12179477
DOI: 10.1177/26334895251346816

Abstract

Background: Clinicians, health care organizations, and families demand better and more accessible children's mental health services with greater patient engagement. The I-InTERACT-North program was developed for children following traumatic brain injury and adapted for a transdiagnostic neurological and neurodevelopmental focus, with a recent transition to a stepped-care model. To date, the program has been exclusively provided within research studies; however, demand for its clinical use is growing. Implementation frameworks provide essential guidance regarding facilitators and barriers of clinical implementation under real-world conditions. Similarly, intersectionality evaluation can provide insights to develop equitable and inclusive health care practices. Informed by the Consolidated Framework of Implementation Research 2.0 (CFIR) and recent intersectionality supplement, the objectives were to examine the perspectives of parents/caregivers and clinical partners involved in the I-InTERACT-North program to identify (a) facilitators and barriers to inform the scale and spread of the program, and (b) equity, diversity, and inclusion (EDI) considerations to integrate in future clinical implementation.

Method: This study used a qualitative descriptive design with focus group methodology. Participants included parents/caregivers and clinical partners. Semi-structured focus groups were conducted virtually. Focus group data were coded inductively and deductively using CFIR 2.0. The team reflected on intersectionality in the data, coding results, and broader context of the program's history.

Results: Positive perceptions of the innovation's relevance and adaptability were echoed across focus groups. Prominent facilitators included the program's adaptability, personalized, flexible format, and knowledge dissemination. Barriers included geography, technological accessibility, and workflow, with participants stressing the importance of tailoring to culture, language, and neurodiversity. Feedback from participants aligned with 10 reflective prompts highlighted within the CFIR intersectionality supplement pertaining to families' intersecting categories, diverse intervention experiences, and information access.

Conclusions: Identified facilitators of I-InTERACT-North implementation extended across program knowledge sharing and recruitment. Recommendations included directions for clinical and system integration to facilitate scalability.

Keywords: behavioral health; children/child and adolescent/youth/family; co-creation; mental health intervention; participatory design.

Plain language summary

Transitioning a stepped-care mental health parenting program (I-InTERACT-North) from research to clinical care: Recommendations from families and clinicians Plain Language Summary I-InTERACT-North is a virtual positive parenting support program designed for neurodiverse children (i.e., Brain Injury, Attention Deficit Hyperactivity Disorder (ADHD), Autism (ASD)). Participation in this program improves parent-child relationships, child behavior, and parent stress. To enhance feasibility and better meet families’ needs during the pandemic, our team adapted to a stepped-care approach. Stepped-care offers effective treatment tailored in intensity and level of therapist involvement to family needs. Using focus groups of parents and clinical partners, the current study identified facilitators and barriers to inform optimal clinical implementation and expansion of the program beyond our institution. Suggestions included strategies to inform more families about the program, build connections with community agencies, and ways to promote patient diversity and inclusivity. Recommendations also pertained to fitting and funding the program. Results overall highlighted the benefit of ongoing work with families to design and inform the program's clinical implementation.

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Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

References

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Scaling up: Facilitators, barriers, and EDI considerations for clinical implementation of a stepped-care early mental health parenting program (I-InTERACT-North)

Affiliations

Scaling up: Facilitators, barriers, and EDI considerations for clinical implementation of a stepped-care early mental health parenting program (I-InTERACT-North)

Authors

Affiliations

Abstract

Plain language summary

Conflict of interest statement

References

LinkOut - more resources

Full Text Sources