Abstract
Background: Mental health and substance use disorders among youth continue to be of critical public health concern in Canada, and urgent action is required within the health system to better respond to the evolving health and wellness needs of youth. Foundry, an integrated youth services (IYS) initiative in British Columbia (BC), is piloting a learning health system (LHS) framework at two (out of 7) operational IYS centres. The goal of Foundry LHS is to optimize the flow of data to knowledge to practice, supporting rapid adaptation and the continuous improvement of service delivery, experiences, and wellness outcomes for youth. The objective of this study was to elucidate learnings from the pilot experience and identify the barriers and facilitators to LHS implementation in an IYS context.
Approach: This study was co-designed with the IYS initiative and incorporated an integrated knowledge translation approach. Participants (n=2) were purposively recruited from the LHS implementation team and Foundry Central Office (i.e., the backbone organization supporting the community-based IYS centres). Individual interviews were conducted at the pre- and post-implementation stages of the pilot LHS project and followed a semi-structured guide to broadly capture knowledge and perceptions of the LHS framework, barrier and facilitators to its implementation, and the potential impact on the IYS and its community. Data were analyzed using directed content analysis, guided by the Theoretical Domains Framework and COM-B model. Overarching themes and subthemes were generated, and findings were further interpreted to determine the barriers and facilitators to implementing the LHS in an IYS context, as well as other key learnings from the pilot implementation process.
Results: This real-world case study highlights the importance of ensuring that LHS values and structures are incorporated into the overall organizational culture of an IYS initiative. Key themes in participant perception of barriers to the pilot implementation included a lack of clarity, shared vision, change management, and meaningful engagement, leading to limited buy-in and motivation for change. Strong governance, leadership, operational support, and dedicated resourcing over time emerged as strong themes critical to the successful implementation of the LHS in an IYS context. Participants saw the pilot LHS project as an invaluable learning experience and perceived early barriers to be future facilitators of the LHS in this context. Importantly, participants felt that the IYS organizational values, people, and infrastructures were highly aligned with an LHS way of working. These ideas reflected major facilitators and were thought to have created optimism and motivation to continue the work of implementing an LHS across the initiative.
Implications: Learnings from this project reveal important challenges and opportunities related to the implementation of an LHS within a dynamic and evolving IYS initiative. Results will be integral to informing the continued development, implementation, and scale-up of the LHS within the IYS context in BC and beyond.