Abstract Background We previously developed YouthCHAT, a youth programme for electronic screening and intervention for lifestyle risk factors and mental health issues. Our aim was to tailor the YouthCHAT package for use in a clinic catering for disadvantaged youth, assess its acceptability and utility, and develop a framework to scale-up its implementation. Methods We used a community-based participatory research approach to implement YouthCHAT in a rural clinic in New Zealand. Modifications to the programme were developed using an iterative process involving clinicians and patients. Electronic YouthCHAT data were collated and descriptive statistics produced. Quantitative data from post-consultation youth surveys were analysed, with thematic analyses undertaken of free text responses and staff interviews. A generic implementation framework was developed with modifiable components. Results Thirty youth, predominantly female Māori, completed electronic screening then attended their clinician. Consultations included discussion of YouthCHAT responses, with joint problem-solving and decision-making regarding intervention. Twenty-seven (90 %) screened positive for at least one domain. Nineteen (67 %) had one to three issues. Sixteen (53 %) wanted help with at least one issue, either immediately or later. Patients gave YouthCHAT high acceptability ratings ( M = 8.29/10), indicating it was easy to use, helped them think about and identify problems, talk with their doctor, and assisted their doctor to be aware of these issues. They liked that YouthCHAT kept them busy in the waiting room and gave them time to reflect on their responses, and what to discuss with their clinician. Clinicians felt that YouthCHAT was acceptable to their young patients because it was electronic and reinforced their privacy. They indicated YouthCHAT identified problems that would have not been identified in a normal consult, and improved consultations by making them faster. The clinic continues to use YouthCHAT post-study. Conclusions A community-based participatory approach was used to engage key stakeholders (patients and clinic staff) for ‘real life’ translation of an electronic mental health and lifestyle screening and intervention package into a specific youth clinic context. Patients and staff found the programme acceptable and useful, and a framework was developed for scaled up and sustainable tailored implementation in other settings.