Implementation of a Knowledge Management System in Mental Health and Addictions: Mixed Methods Case Study.

BACKGROUND: Mental health and addictions (MHA) care is complex and individualized and requires coordination across providers and areas of care. Knowledge management is an essential facilitator and common challenge in MHA services. OBJECTIVE: This paper aimed to describe the development of a knowledge management system (KMS) and the associated processes in 1 MHA program. We also aimed to examine the uptake and use, satisfaction, and feedback on implementation among a group of pilot testers. METHODS: This project was conducted as a continuous quality-improvement initiative. Integrated stakeholder engagement was used to scope the content and design the information architecture to be implemented using a commercially available knowledge management platform. A group of 30 clinical and administrative staff were trained and tested with the KMS over a period of 10 weeks. Feedback was collected via surveys and focus groups. System analytics were used to characterize engagement. The content, design, and full-scale implementation planning of the KMS were refined based on the results. RESULTS: Satisfaction with accessing the content increased from baseline to after the pilot. Most testers indicated that they would recommend the KMS to a colleague, and satisfaction with KMS functionalities was high. A median of 7 testers was active each week, and testers were active for a median of 4 days over the course of the pilot. Focus group themes included the following: the KMS was a solution to problems for staff members, functionality of the KMS was important, quality content matters, training was helpful and could be improved, and KMS access was required to be easy and barrier free. CONCLUSIONS: Knowledge management is an ongoing need in MHA services, and KMSs hold promise in addressing this need. Testers in 1 MHA program found a KMS that is easy to use and would recommend it to colleagues. Opportunities to improve implementation and increase uptake were identified. Future research is needed to understand the impact of KMSs on quality of care and organizational efficiency.

Adolescents' attitudes and opinions about depression treatment.

The purpose of this study was to determine adolescent preferences for depression treatment. Adolescents (n = 156) completed a survey that included: their preferences for type of depression treatment and the method of delivering it; their perception of the importance of side effects of depression treatments and a rating of their willingness to seek treatment if they were depressed. A screen for depressive symptoms (CES-D10) was also completed. Adolescents showed higher preference for psychotherapy than antidepressants. Greater severity of depression symptoms, perceived social support for the particular treatment modality, and general willingness to seek treatment predicted greater preference for psychotherapy than for antidepressants. Family doctors, psychiatrists, and psychologists were the preferred treatment providers, and adolescents preferred that treatment be delivered in a private office. Weight gain was the most deterring side effect of antidepressants for girls and loss of sex drive for boys. Adolescents' preference for psychological therapy suggests that broader availability of psychotherapy may enhance help-seeking and compliance in depression treatment in this vulnerable population.

Factorial validity of the Center for Epidemiological Studies Depression 10 in adolescents.

The Center for Epidemiological Studies-Depression (CES-D) Scale's 20-item version is well-validated and reliable for detecting depressive symptoms in adolescents in community samples. A shortened version, CES-D 10 has not been validated with adolescents, but has demonstrated strong psychometrics in other populations. The purpose of this study was to test the factorial validity and internal consistency of the CES-D 10 in adolescents. Using data from 156 adolescents in a previous community-based study, we tested three models of the underlying factors of the CES-D 10 using Structural Equation Modeling (SEM) based on factor models validated in other populations. A two-factor model comprised of depressive affect and positive affect was found to be the model that best fits the data (RMSEA = 0.016, CFI = 0.98, GFI = 0.95, AIC = 97.43, BIC = 191.98). These findings are consistent with other studies in adults and provide initial support for the use of the CES-D 10 as a depression screen for adolescents in the community. The utility of a brief screen for adolescents in the community is high, given that many adolescents do not know they need help or are reluctant to seek help. The CES-D 10 could be used as a depression screen for adolescents at a population level and in health clinics.