Table 1.

Summary of key findings.

Themes and subthemes			Key findings
Theme 1: Digital tools in clinical care with young people
	Build skills, facilitate learning, and monitor symptoms	Clinicians reported using digital platforms was an excellent way to better engage young people in treatment. There was a notable variety in the types of tools that clinicians used, and the main goals of using these tools were to acquire and practice skills, facilitate learning and discussion, and monitor symptoms. An example was the use of mood-tracking apps to facilitate conversations around patterns and precursors to changes in young people’s mental health symptoms. Clinicians noted the importance of considering the child’s developmental stage when deciding their level of involvement in digital tools.
Theme 2: Challenges of using digital tools in practice
	Accessibility	Challenges related to young people’s limited or no access to broadband and/or digital devices outside of treatment sessions were frequently mentioned, expanding the definition of accessibility. Clinicians mentioned other restrictions caregivers and schools placed on smartphone use, such as limits on screen time and the context in which the device can or cannot be used. These restrictions, although typically implemented by parents to promote well-being, can significantly interfere with the ability of adolescents to engage in DMHa programs at times when they perceive themselves most in need of the tools. As for connectivity and smartphone access, our results imply that solutions, such as making content available offline or providing desktop versions, should be considered so that accessibility is not dependent on consistent internet and smartphone access.
	Outdated programs and limited content	Although clinicians could see the utility of digital platforms beyond outdated designs, young people were often deterred from initially engaging or maintaining sustained use with these platforms based on the outdated design. Similarly, other digital tools clinicians used had limited content, and thus their clients would become bored quickly or tire easily of these apps because they ran out of new content quickly. To combat the vast drop-off observed in these instances, clinicians underscored the importance of keeping the design and content of young people–facing platforms fresh and up to date.
Theme 3: Desired digital platform and integration considerations
	Centralized digital platform	Several clinicians desired a centralized digital tool that securely connected the clinician, the young person, and the young person’s family. Clinicians were especially drawn to the possibility of this tool to help generalize skills learned in sessions to young people’s day-to-day lives, track mood patterns in real time to discuss in treatment, and increase parent communication and engagement in their child’s treatment. For this to be effective, clinicians underscored the importance of building rapport and attaining buy-in from parents and other stakeholders so that teens have access to devices and services to use as therapy resources when triggered at school or home.
	Considerations for integration into care	Regarding the design of the young person–facing platform, clinicians emphasized the importance of visuals, compared with primary text, and features, such as earning badges and creating avatars, to keep young people engaged. Clinicians underscored the importance of designing the program brand to be discreet and having other privacy features programmed to ensure confidentiality of mental health information stored on devices. Clinicians unanimously agreed that using digital tools to augment therapy would be most effective if a human, such as a therapist, parent, or teacher, was behind this tool to check in with and guide young people. Another consideration discussed when using digital tools to augment therapy was the importance of setting up expectations and boundaries with the young person and parents so the capabilities of the tool can be understood by them. Clinicians also suggested working with the families so that it is understood that immediate help may not be available via this modality in crisis situations and to create a safety plan for those instances. Another strategy mentioned to mitigate the risk of an unrecognized crisis communicated via digital devices was to program the tool to automatically detect and guide the young person to the appropriate contact and resources.

^aDMH: digital mental health.