This protocol begins with an explanatory sequential mixed-methods assessment of organisational readiness to implement Measurement-Based Care (MBC) in a specialised paediatric obsessive-compulsive disorder (OCD) clinic. Phase 1 uses the Readiness Thinking Tool to quantify readiness domains and applies the Consolidated Framework for Implementation Research (CFIR) to identify contextual determinants that might support or impede implementation. The goal of this phase is to produce a nuanced understanding of organisational capacity, staff attitudes, workflow constraints and other local factors that should inform subsequent implementation planning.
Quantitative readiness data will be collected and complemented by qualitative exploration to explain survey findings and identify site-specific barriers and facilitators. The mixed-methods explanatory sequential design permits tailoring the implementation plan to the micro-context of the tertiary care programme by linking readiness metrics to targeted strategies.
Phase 2 translates readiness findings into an operational implementation plan guided by the Quality Implementation Framework (QIF). Planning activities are co-designed with stakeholders and emphasise practical steps such as workflow integration, staff training and iterative refinement. The plan aims to embed routine use of patient-reported outcome measures (PROMs) into clinical processes and to create procedures that clinicians, youth and caregivers can routinely follow.
Stakeholder co-design is central: clinicians, clinic staff, youth and caregivers contribute to defining feasible workflows, data capture processes, and training needs. Staff training is intended to increase competence and confidence in administering PROMs, interpreting scores and using results to inform collaborative treatment decisions. Iterative refinement cycles will allow the team to adapt workflows based on early feedback and operational experience.
The MBC model adopted for the programme integrates five PROMs: two general mental health measures and three OCD-specific domains. These instruments are intended to routinely monitor symptom trajectories and provide structured information to inform collaborative treatment decisions between clinicians, youth and caregivers.
PROM completion and score tracking are core operational elements. The protocol specifies routine capture of PROM completion rates and score data as quantitative indicators of fidelity and patient-level outcomes. No specific PROM instrument names or scale details are reported in the source; the study focuses on functional integration of the selected measures into clinic workflows.
Phase 3 conducts a convergent mixed-methods formative evaluation of early implementation outcomes. Evaluation is structured around the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to assess breadth of uptake, preliminary effectiveness signals, clinician and service adoption, fidelity of implementation, and early indicators of sustainability.
Complementing RE-AIM, CFIR guides the examination of contextual and organisational determinants that influenced implementation outcomes. This combined approach seeks to link implementation processes and context to observed results, identifying which implementation strategies succeed in the specialised tertiary paediatric mental health setting.
Quantitative implementation outcomes will include measures such as PROM completion rates, adoption metrics and other service-level indicators. Qualitative data from stakeholders will provide depth on acceptability, feasibility and perceived utility of MBC during early implementation.
The study uses multiple data sources: clinician, youth and caregiver surveys; semi-structured interviews with stakeholders; PROM completion and score data; and implementation field notes. This multimodal data collection supports triangulation of findings across methods and respondent groups.
Quantitative data will be analysed descriptively to summarise readiness scores, PROM completion rates, adoption metrics and other measurable implementation indicators. The protocol specifies descriptive analyses rather than inferential hypothesis testing for the early implementation evaluation.
Qualitative data will be analysed using a CFIR-guided directed content analysis approach. This analytic strategy will map emergent themes to CFIR domains to explicate contextual determinants, barriers and facilitators. The mixed-methods convergent design in Phase 3 will integrate quantitative and qualitative findings to provide a comprehensive formative evaluation.
Ethics approval for the study was obtained from the University of Calgary Conjoint Health Research Ethics Board. The investigators plan to disseminate findings through peer-reviewed publications, conference presentations, stakeholder workshops, clinic feedback sessions and policy-focused knowledge exchange activities.
The study aims to generate implementation knowledge to inform integration and sustainment of MBC within specialised paediatric mental health services. By linking readiness assessment, structured implementation planning and formative evaluation, the project intends to produce a context-specific, practice-oriented implementation blueprint for MBC in a paediatric OCD clinic. This blueprint will be oriented toward real-world workflows, staff training needs and sustained PROM use in a tertiary multidisciplinary care setting.
The protocol addresses an identified evidence gap: while MBC has been studied in community, school-based and general outpatient paediatric mental health contexts, there is limited evidence on implementation strategies tailored to specialised tertiary services. The outputs from this single-site study are intended to inform other specialised paediatric mental health programmes considering MBC integration.