What this trial measures

• Physician Belief ScaleSurveys will be collected prior to implementation, then continue every six months for a total of 2 years.

  Attitudinal constructs will be measured using a 14-item measure indexing providers attitudes toward management of psychosocial problems and comprises of two subscales (Belief and Feeling, Burden) (McLennan et al., 1999). Including one item to asses burnout. Utilizes a 5 point Likert Scale, with 1 being Strongly Disagree and 5 Being Strongly Agree.

• Organizational ConstructsSurveys will be collected prior to implementation, then continue every six months for a total of 2 years.

  Implementation Climate Scale, an 18-item measure of the degree to which the organizational climate is supportive of evidence-based practice (EBP) adoption and consists of six subscales (focus on EBP, educational support for EBP, recognition for EBP, rewards for EBP, selection for EBP, and selection for openness). Utilizes a 5 point Likert-type Scale, with 0 being "Not at All" and 4 being "Very great extent". Implementation Leadership Scale (Aarons et al., 2014), a 6-item measure of leadership support for EBP, specifically Peds IBH, implementation and Primary Care Dynamics Survey. Which is also a 5 point Likert-type Scale, with 0 being "Not at All" and 4 being "Very great extent". And an 11-item measure of primary care team dynamics (Song et al., 2015), from which we included two subscales (process for communication and information exchange, and acting and feeling like a team). Which uses a Utilizes a 5 point Likert Scale, with 1 being "Strongly Disagree" and 5 being "Strongly Agree".

• Implementation OutcomesSurveys will be collected prior to implementation, then continue every six months for a total of 2 year.

  Behavioral Health Screening, Referral, and Consultation Experience and Implementation, developed to assess provider-reported behavior and includes seven items at pre-implementation and 10 at mid- and post-implementation. All questions using a visual analogue scale, with 0 being the lowest and 100 being the highest.

• Acceptability, Feasibility, and Appropriateness MeasureSurveys will be collected prior to implementation, then continue every six months for a total of 2 year.

  Acceptability of Intervention, Intervention Appropriateness, and Feasibility of Intervention Measure, a 12-item measure of the acceptability, feasibility, and appropriateness of the implemented program, Peds IBH. Which uses a Utilizes a 5 point Likert Scale, with 1 being "Completely Disagree" and 5 being "Completely Agree".

• System Usability ScaleSurveys will be collected prior to implementation, then continue every six months for a total of 2 year.

  Systems Usability Scale, a 12-item measure of the usability and learnability of a given system, which was adapted to assess the Kiddie-Computerized Adaptive Tests (K-CAT) screening tool. Utilizes a 5 point Likert Scale, with 1 being Strongly Disagree and 5 Being Strongly Agree.

• Provider Report of Sustainment ScaleSurveys will be collected prior to implementation, then continue every six months for a total of 2 years.

  Provider Report of Sustainment Scale, a 3-item measure of the sustainability or continued use of the implemented program, Peds IBH. Utilizes 5 point Likert Scale, with the lowest point being "Not at all" and the highest point being "To a Very Great Extent".

• Confidence in Ability to Identify Behavioral Health Concerns and Connect to ServicesSurveys will be collected prior to implementation, then continue every six months for a total of 2 years.

  Barriers encountered when implementing the Peds IBH program, and suggested improvement/resources/trainings using seven items. Utilizing an 11 point Likert Scale, with O being the lowest and 10 being the highest. As well as 3 open-ended text box questions.

• Screening RatesFrom clinical trial launch, data will be collected twice a year, for a total of four years

  Percent of youth screened for Mental Health Disorders. Measuring screening rates as the percent of 7- to 17-year-olds who have PSC-17 and/or PHQ-2/-9 screening results.

• Referral RatesFrom clinical trial launch, data will be collected twice a year, for a total of four years.

  Percent of youth referred to FIRST therapy for treatment. Referral rates to the Peds IBH program as the percent of patients with a positive screen who are referred to the Peds IBH program.

• PEDS-IBH Implementation Opinion via Clinic InterviewsInterviews will be collected prior to implementation, then continue every six months for a total of 1 year

  Semi-structured interviews involving a Nurse/MA, PCP, and clinic manager of participating PEDS-IBH clinics. Interviews will be conducted virtually by a member of the implementation team. Interviews will inquire about the process for determining if a youth is in need of behavioral health services and shifts in this process following Peds IBH program implementation; their clinic's behavioral health screening and referral process; and Peds IBH program feasibility, fit, integration, implementation, and barriers and facilitators to implementation.

• Provider 2 Provider (P2P) Consultation CallsFrom clinical trial launch, data will be collected twice a year, for a total of four years.

  Number of P2P Consultation Calls. Data will be provided from the BeHappy and AAA consultation lines on number of consultation calls from participating clinics.

• Top Problem AssessmentFrom clinical trial launch, data will be collected twice a year, for a total of four years.

  Youth and their caregiver(s) who participate in the FIRST intervention will complete the Kiddie-Computerized Adaptive Tests (K-CAT) at pre- and post-treatment and Top Problems Assessment at each session to evaluate treatment outcomes. The K-CAT and Top Problems Assessment will be administered as part of routine care for youth receiving the FIRST intervention. The Top Problems Assessment is an idiographic assessment of youth and caregiver identified top problems.

• Assess Youth Engagement in ServicesFrom clinical trial launch, data will be collected twice a year, for a total of four years.

  Measure rates of youth engagement in the Peds IBH program. This data will be collected through administrative data in the EHR. We will measure 1) the percent of youth referred to the Peds IBH program who schedule a Peds IBH assessment appointment, 2) the percent of youth who have a scheduled assessment appointment who attend the appointment, 3) the percent of youth indicated as appropriate for Peds IBH services who attend at least one session of FIRST, and 4) the number of total FIRST sessions attended.