Extending reach while maintaining oversight: Clinicians' perspectives on digital mental health implementation in youth services

Background Digital mental health interventions (DMHIs) offer a promising means of extending care for children and adolescents, yet their integration into routine clinical services remains inconsistent. The implementation conditions clinicians identify as prerequisites for adoption carry greater relevance given the emergence of AI tools now being used by young people. This study examined the perspectives of mental health professionals (MHPs) working with children and young people to identify key implementation considerations for the development and adoption of DMHIs. Methods Nineteen focus groups were conducted with 50 mental health clinicians from a range of service settings in Queensland, Australia between May 2020 and May 2021. Data were analyzed using a mixed deductive-inductive thematic approach informed by the Consolidated Framework for Implementation Research (CFIR). Results MHPs were cautiously optimistic about DMHIs, viewing them as most valuable when implemented as supplementary rather than replacement tools. Key perceived uses included waitlist support, screening and assessment, between-session engagement, and flexible treatment pathways. However, MHPs consistently emphasized the need to preserve clinical judgement and oversight across all stages of DMHI use. Risk management, duty of care, and privacy and confidentiality were identified as critical prerequisites for implementation. Conclusions Successful DMHI implementation in child and adolescent mental health services requires flexible, clinician-centered integration approaches, robust risk management protocols, and clear organizational frameworks delineating clinician responsibility. As AI tools are adopted by young people largely outside clinical oversight, these findings offer a grounded baseline for evaluating what needs to be in place before adoption decisions are made.