Table 1 Key themes regarding provider, parent, and adolescent attitudes toward the CDSS-YD

Providers, parents, and adolescents viewed the CDSS-YD as helpful for treatment.

Providers, parents, and adolescents viewed the CDSS-YD as an informative and useful tool for personalized treatment planning.

“I think it’d be helpful because sometimes even the parents or the team don’t necessarily know what might be helpful in their situation. So this would kind of be a nice way of, ‘Well, let’s do this assessment tool we have and see what, based on your answers, where the benefit might be.’” -Provider

“I guess for me just thinking if I had this, then perhaps we would have saved my daughter six months’ worth of therapy that was not going to be helpful. " - Parent

“I think it’s helpful. You know, you might be in a situation where you’re not real big on medicine and you might think that all clinicians that you see are going to be recommending medication. So if you take this survey, and based on your answers the survey is pointing them in this direction, it’s kind of like an affirmation. It would kind of be like getting more of just one single person’s opinion as to what the treatment plan should be” - Parent

“I think it’s nice just because it has an answer right there. Like you took this poll, and it’s not like you’re dissecting data, it’s just it gives you an answer of what a possible solution is that would be very helpful based on data.” - Adolescent

Providers, parents, and adolescents believed that use of the CDSS-YD could foster a stronger therapeutic relationship

“And I was just going to say, I think data always helps kind of give families trust in you. Being you’re not just throwing this recommendation out without having good knowledge behind it. And I think just having this. This is kind of what those showed us and there’s research to kind of help prove behind that it is effective. I think that can always help in relationships.” - Provider

“I think anytime you’re working with teens, asking for their input is always a good building block. Because often, I think they feel that they don’t really have a say in a lot of things, and it’s not their choice. So I think that part’s really nice.” - Provider

“It opens up like the conversation… the provider, the adolescent, and the parent.” - Parent

“I think it would help because it just sort of like throws everything out in the open. Like it just is like ‘Yeah, you do have a problem with this and this and this.’ It’s not just like you kind of avoiding answering questions if you answer truthfully on the survey. I think it would help, especially if you are talking about it separately from your parents, being able to discuss the results or treatment options. I just think it would help.” -Adolescent

Providers, parents, and adolescents differed in their views of the trustworthiness of the CDSS-YD.

Providers and parents viewed the CDSS-YD as trustworthly because it is research-based and the treatment recommendation is data-driven.

“The fact that it was based on a study for me helped increase it.” -Provider

“I think data always helps give families trust in you - being you’re not just throwing this recommendation out without having good knowledge behind it.” -Provider

“I’m a data person so if you give me data and studies and say this came from studies of a lot of people and this is how this tool came about, I’m more apt to agree to a treatment recommendation than to say well we’ll try therapy first.” - Parent

Use of the CDSS-YD increased parents’ trust in the provider and their perception of provider expertise.

“I think it would affirm that providers know that these particular sets of answers lead to this conclusion instead of just tossing out ‘Oh, let’s try this or whatever.’ So in that respect, it would make me feel more comfortable that they really know that they’re talking about.” - Parent

Youth viewed the CDSS-YD treatment recommendation as less trustworthy than a provider recommendation.

“Personally probably [I’d trust] a doctor just because there’s always room for human error but doctors have been doing it for a long time and they’ve had training and everything. I mean, personally I think I would trust a doctor’s opinion more.” - Adolescent

“Doctors have been doing this for decades and decades. And this algorithm has been at it for I don’t know how many years but I can’t imagine it being as long.” - Adolescent

Parents and adolescents saw their providers as having a critical role in the use the CDSS-YD.

The provider’s opinion of the CDSS-YD treatment recommendation was a facilitator of families’ trust.

“How much the therapist that you’re going over the treatment with. I mean, if they’re putting trust in it, then it’s more likely that you’re going to be trusting the recommendation.” - Parent

“I think if a doctor was like yeah I agree with this recommendation based on your personal history and how you answered the questions I think that would make it better.” - Adolescent

It is important for the CDSS-YD to be used in the context of a discussion with the provider.

“The doctor is there and can break it down more too.” - Parent

“And having someone there to say hey, what does this mean? What does this mean for us? Or what’s common, right? So I think having that interaction with a provider, a professional what have you I think is, for me what would make it better which is already happening.” - Parent

“The section provides a lot of information but it has you deal with it on your own. Unless you’re a super good medical professional that knows exactly what you’re doing, it’s going to be hard to make a judgement off of that.” - Adolescent

Providers, parents, and adolescents expressed a desire to understand how the questionnaire responses informed the CDSS-YD’s treatment recommendation.

“I think it might be helpful to maybe even have a brief description of why those ones are recommended.” - Provider

“And for me this is not really clear…the reason why you’re recommending your treatment” - Parent

“Even though it tells me the statistics on me, it doesn’t tell me how they came to the conclusion.” - Adolescent

Adolescents expressed discomfort with sharing their questionnaire results with the parents, and they expressed a desire for privacy when reviewing the CDSS-YD results with the provider.

“And I think that my parents specifically would look at it and then decide something for themselves and be like ‘Oh, you have inattention; you should have a tutor.’ It isn’t necessarily what I would need.” - Teen

“It’s just kind of uncomfortable for me, especially I don’t really like telling them how I’m feeling. I know it’s necessary, but just, like, being there for that is kind of just weird to me.” - Adolescent

“I think personally I would just rather have to look at that separately so I wouldn’t have to deal with that information, but also have to deal with my parents’ reactions to it, I guess. I feel like that would be a lot harder to do.” - Adolescent