Telehealth system improves referral process for pediatric mental health specialty services 

1. Patients were >3 times more likely to complete an initial screening visit with community mental health systems (CHMCs) when using a telehealth-based referral system compared to the traditional phone call process.

2. Parents reported higher satisfaction with the telehealth referral process and with overall care compared to the traditional system.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Prevalence of mental health (MH) disorders is rapidly increasing among the United States pediatric population, yet most of these children do not have access to the services needed to adequately treat their disease. African American and Latino children, as well as those living in poverty, are simultaneously at higher risk for MH and less likely to receive adequate services. Fragmented care systems are a major barrier to access for all children. Investigators in this study tested the effectiveness of a telehealth-based system in improving the access to care at CMHCs after initial referral from primary care providers (PCPs) in low-income communities. Investigators randomly assigned participants to receive CMHC eligibility screening visits via telehealth services (intervention) and compared completion rates to participants randomly assigned to the traditional referral process (control). Results showed that children in the intervention group had over 3 times higher odds of completing the initial screening visit compared to participants in the control group.  Parents in the intervention group reported significantly higher rates of satisfaction with the referral system and with overall care compared to those in the control group. This study is limited by generalizability and lack of information on effects of this intervention on overall clinical outcomes. Results suggest the potential for improved care access for children with MH disorders, and pediatricians in other low-resource communities should explore the use of telehealth services in improving access to MH services and overall health.

Click to read the study, published today in Pediatrics

Click to read the commentary, published today in Pediatrics

Recommended reading: Unmet need for mental health care among U.S. Children: variation by ethnicity and insurance status

In-depth [cluster randomized trial]: In this randomized cluster trial, investigators randomized 342 children (87% Latino, 64.6% household education high school or less) referred to a participating CHMC to receive the initial screening visit via telehealth services (intervention group; N=164) or via the traditional process (control group; N=178).  Traditionally, a referral form is faxed from the PCP to the CHMC office, and a CHMC representative subsequently telephones the patient’s family to complete the eligibility screen. With the telehealth intervention, parents watched an introduction video at the time of referral, then scheduled a return visit at the PCP’s office, at which time they connected with the CHMC representative to complete the eligibility screen via the telehealth system. All parents who completed the eligibility screen were asked to complete a 6-month follow-up survey on satisfaction with various aspects of the process. Results indicated that children in the intervention group were 3 times more likely to complete an initial screening visit compared with the control group (80.49% vs. 64.04%, aOR 3.17, 95% CI 1.46 to 6.91), however the average number of days between referral and screening was high among the intervention group (23.6 days vs. 17.1, P=.01). Among those who completed the screening visit, there was no significant difference between groups in terms of those who completed the in-person intake visit (80.2% intervention vs. 83.5% control). Of the parents who completed ≥1 CHMC therapy visit, those in the intervention group versus control group reported greater satisfaction with the referral system (8.8 vs. 7.9, respectively, P=.003) and with overall care (9.1 vs. 8.6, respectively, P=.01), though there was no significant difference in quality of life at the 6-month follow-up.

Image: PD

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