Improving Digital Measurement-Based Care Within Emerging Adult Mental Health Care Pathways: Protocol for a Co-Design Phase Embedded in a Multimethod Rapid Learning Health System Study

Abstract

BACKGROUND: Emerging adults (EAs), typically ranging from 18 to 29 years, navigate a transitional period marked by rapid developmental, social, and psychological change. Despite heightened vulnerability to mental health (MH) concerns during this stage, service systems are often fragmented, with gaps between adolescent and adult care streams that leave many EAs without developmentally appropriate support. In response, developing approaches such as transdiagnostic stratification, which structures care around shared symptom processes and informs treatment intensity, and digital measurement-based care (dMBC), based on routine patient-reported outcome measures (PROMs), have gained traction but remain challenging to implement consistently. This reinforces the need for rapid learning health system (RLHS) approaches that leverage continuous data and feedback for ongoing improvement, as well as co-design (CD) methods that meaningfully integrate EA perspectives into service improvement. OBJECTIVE: This research protocol describes a CD phase of an implementation study integrated into an RLHS, aimed at developing implementation resources to support the ongoing use of dMBC within EA MH services. Anticipated resources include clinician-facing workflow supports, guidance for using client-reported data in clinical decision-making, EA-oriented materials to support engagement with measures, and implementation planning resources to support uptake across the care pathway. Each co-designed resource will be developed to function across core stages of care, including intake, therapy, and treatment discharge. METHODS: We used a concurrent multimethods design, integrating quantitative and qualitative approaches within a dual methodological framework combining user-centered design with participatory design to structure the CD process. EAs, clinicians, and clinical service leaders participated in a series of semistructured CD sessions to identify implementation needs and inform the development and refinement of implementation resources. Data collection and analysis began in January 2026 and are anticipated to conclude in November 2026. RESULTS: As of August 24, 2026, 17 emerging adults and 20 clinical staff participants remained enrolled in the co-design phase. Both emerging adult cohorts had completed 6 co-design sessions, while clinical staff groups had completed 5 sessions, with final resource review ongoing. Data analysis and implementation resource finalization are expected to be completed by November 2026, with findings anticipated for publication in 2027. CONCLUSIONS: This study phase is expected to demonstrate the value of integrating CD within an RLHS to advance more responsive, contextually grounded dMBC implementation in EA MH care, while also contributing insights that can strengthen future CD efforts with this population. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/93038.

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