Implementing Stay Strong AIMhi for Youth: Protocol for Evaluation

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Background: Good mental health and well-being are essential for fulfillment, productivity, and resilience. Mental disorders cause high levels of disability and economic impact worldwide. Vulnerable groups at significantly higher risk include youth and First Nations people. As the demand for mental health support and services increases, there is an urgent need to expand access to culturally appropriate quality mental health services (particularly for young people) and to promote self-care through integration of mobile health technologies. Objectives: This paper describes a protocol to evaluate implementation of the AIMhi for Youth support package into youth wellbeing services in urban, rural, and remote Northern Territory and South Australia. Codesign workshops will tailor the resources to these and other locations. The AIMhi-Y support package will be implemented as an innovative approach to suicide prevention through three years of codesign, training, implementation support and dissemination. Methods: Implementation is guided by the Consolidated Framework for Implementation Research (CFIR) incorporating the recent CFIR Outcomes Addendum and including strategies from the Expert Recommendations for Implementing Change. The protocol incorporates best practice principles in codesign and First Nations research. It builds on a decade of foundational work of the Stay Strong program implementing digital mental health resources in primary care and specialist settings. Implementation and related outcomes will be evaluated from each participant perspective (user, service provider, decision maker, First Nations people with lived experience and cultural consultants) using surveys and small group discussions. Intervention: AIMhi for Youth is a culturally responsive digital mental health solution codesigned with First Nations leaders and young people. Delivered via mobile device it is a gamified app supporting skills development in mental health literacy, emotional regulation, help seeking and goal setting. The app provides a structured intervention which complements existing services and addresses key risk factors for suicide and compromised mental health. The package includes training workshops and supplementary multimedia resources. Support resources will be hosted on a tailored website creating a seamless accessible ecosystem for users. Discussion: At the time of publication, 514 young people and 363 individual service providers have used the app, and 11 services have engaged in implementation planning discussions. Through our implementation evaluation we will identify why the AIMhi-Y package was implemented successfully in some contexts and not in others and will have an evidence-based strategy for successfully engaging First Nations young people and services in digital mental health solutions. This will inform further AIMhi-Y dissemination and provide a guide for implementation of other innovations in similar contexts. Conclusion: This study prospectively plans, monitors, and evaluates implementation through use of the Consolidated Framework for Implementation Research. This threefold approach potentially strengthens the design and enhances likelihood of implementation success. The emphasis on Indigenist research principles, and the addition of measuring outcomes including reach, impact, adoption, implementation, and sustainment, has potential to contribute to conceptual development and clarification of implementation approaches in First Nations communities.