Clinicians' Perspectives and Experiences of Barriers, Enablers and Implementation of a Child and Adolescent Mental Health Crisis Service: A Qualitative Evaluation of the Safeguards Team Program

BACKGROUND: Presentations of children and young people (CYP) to Emergency Departments (ED) for acute mental health (MH) issues have increased globally and in Australia. The Safeguards Teams Program (STP) was implemented to provide acute, rapid response, recovery-focused, trauma-informed brief intervention. This study aims to explore clinicians' perspectives and experiences implementing the STP, including barriers, facilitators and suggestions for programme improvement. METHODS AND MATERIALS: This study used a qualitative approach by employing in-depth interviews. Participants were recruited using purposive sampling. The interview transcripts were coded and analysed thematically. RESULTS: Key themes included perceived barriers to implementation, programme enablers and suggestions for improvement. Enablers of successful implementation included structures that supported clinicians' outreach and service accessibility, a centralised and flexible referral model that clinicians perceived facilitated timely care, and opportunities for clinicians' capacity building and collaboration. Clinicians also perceived that the STP supported children and young people experiencing MH crises who may not meet the intake criteria for other services, thereby addressing an important service gap. Perceived barriers included high demand, which increased workload, and challenges associated with the model of care (MoC) in its early stages of implementation. Suggestions for programme improvement emphasised the need for greater contextualisation of services through co-design, a more flexible MoC as part of STP service delivery, and a structured and formalised referral process. Participants also recommended including clinicians with specific skills and cultural awareness, enhancing community awareness, and strengthening integration efforts. CONCLUSIONS: Clinicians perceived the STP as a valuable crisis-response service with the potential to address an important service gap for CYP who need rapid outreach specialist MH crisis response. Findings relating to clinicians' experiences and perceptions of implementing the STP may inform the development, refinement and implementation of similar crisis-response models. Further quantitative research is needed to evaluate clinical outcomes, service utilisation and consumer perspectives associated with the STP.