Exploring barriers and enablers to implementing a digital mental health crisis risk mitigation pathway in acute paediatric care: A multi-site, exploratory mixed-methods study

Objective Children and young people (CYP) presenting in mental health crisis to acute paediatric settings represent a growing clinical and system-level challenge. These environments, primarily designed for physical healthcare, frequently lack tailored, evidence-based digital tools to support risk mitigation and clinical decision-making in safety-critical situations. In response, we co-developed a prototype digital risk mitigation pathway, designed as a clinical decision support system, to enhance safety and care quality for CYP in crisis. This study examined the feasibility of implementing this pathway across diverse general hospital contexts. Methods We conducted a multi-site, exploratory mixed-methods study using a multiple case study design across three acute paediatric hospitals in England. Data were collected between October 2022 and March 2023 through organisational surveys, documentary analysis, semi-structured interviews and focus groups. Qualitative data were analysed inductively, with within-case analysis followed by cross-case synthesis to identify patterns of barriers and enablers influencing implementation feasibility. Results Three organisational surveys were completed, 13 organisational documents analysed, and 30 healthcare professionals participated in interviews and focus groups. Five overarching themes were identified as key determinants of implementation: digital infrastructure; information and communications technology training and support; communication; information governance; and healthcare professional attributes. Marked variation in digital maturity was observed across sites. Feasibility was strongly shaped by the alignment of digital readiness with clinical safety requirements, device availability, workflow integration, governance processes and workforce support in time-pressured crisis care. Conclusion This study provides novel, contextually grounded insights into the organisational and workforce determinants shaping the feasibility of implementing digital decision support in acute paediatric care. Our findings highlight the central importance of aligning digital readiness with clinical safety priorities and addressing multi-level implementation challenges. These insights offer actionable evidence to inform the design, deployment and scaling of contextually responsive digital health interventions for CYP admitted in mental health crisis.