Improving access to mental health services through electronic referral and follow-up

1. Improved mental health appointment show rates were seen after the launch of an electronic referral system to mental health or social work services and social work follow-up protocol.

2. Rates of scheduling first appointments with mental health services and social work also rose; direct mental health outcomes were not measured.

Study Rundown: Mental illness is prevalent, but undertreated in children and adolescents despite the availability of reliable tools for identification of mental health disorders. Quality improvement measures have been implemented in many settings to improve access to care, though the study of the effectiveness of these measures is an emerging field. In this quality report, researchers used data from integrated care clinics at a children’s hospital to compare rates of new appointments and show rates for patients given mental health referrals after implementation of an electronic referral system to mental health or social work services and social work follow-up protocol. The protocol involved warm referrals during adolescent primary care medical visits, phone calls from social work students, and assistance in scheduling and addressing barriers to access. Rates of scheduling first mental health or social work appointments and show rates rose after implementation of these initiatives.

These findings may have limited generalizability to other institutions, but suggest two quality improvement initiatives that may result in improved access to mental health services for patients.

 Click to read the study, published today in Pediatrics

Relevant reading: Integrated Medical-Behavioral Care Compared With Usual Primary Care for Child and Adolescent Behavioral Health: A Meta-analysis

In-Depth [quality improvement initiative]: Researchers used data from primary and integrated care clinics at the University of Pittsburgh Medical Center Children’s Hospital to track rates of new appointments and show rates in 2013 to 2016 for patients aged 12 to 26 years given mental health referrals. Statistical analysis was conducted using process control charts generated by QI Macros to evaluate variability after implementation of an electronic referral system for mental health and social work services and social work follow-up protocol.

Mental health and social work electronic referral were launched in September 2014 and social work follow-up protocol was launched in December 2014. First appointment show rate averaged 51% in the first year and a half of study (November 2014 to March 2016), then averaged 78% in the final 9 months (April 2016 to December 2016). The average overall appointment show rate rose to 77% in the final 14 months of study (November 2015 to December 2016) compared to 67% at the beginning of the study (September 2013 to October 2015).

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