| Sumario: | Background: As part of a clinical trial, four Canadian pediatric emergency departments (EDs) offered an urgent appointment to mental and behavioural health patients being discharged. Objective: To investigate facilitators, constraints, and fidelity in delivery of the urgent appointments. Method: A mixed-method study using concurrent triangulation design was conducted (September 2023 - March 2024). Nineteen of 24 eligible appointment providers completed an online survey to rate how frequently they demonstrated 15 tasks and stances (content fidelity) in appointments. Time-to-appointment, attendance, and duration data were collected and analyzed using descriptive statistics. Virtual interviews were conducted with 21 appointment providers or appointment managers and implementation personnel and were coded using template analysis to understand factors affecting appointment implementation. Results: The use of risk assessments, working with goals and tasks, and relational and curious approaches were frequently reported (74-89% of providers always completed the component). Diagnostic considerations, along with take-home and documentation tasks, had lower use (42-47% of providers always completed). The median time for appointments was within the 96-hour target, with most children attending (ED setting=423/427; outpatient setting=77/88), and appointment length usually met the expected 60-minute duration (range: 45-90 minutes). Appointment scheduling, staffing, scope of practice, and training were identified as challenges to delivery, while ongoing feedback mechanisms and quality improvement strategies served as facilitators. Conclusions: Content fidelity was high for common mental health care practices but lower for more specialized content. Appointment metrics including attendance, duration, and time to appointment demonstrated moderate to high fidelity. Targeted training, feedback, and quality improvement activities are recommended for implementing urgent appointments in other settings.
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