A Telehealth-Enhanced Referral Process in Pediatric Primary Care: A Cluster Randomized Trial

Abstract

OBJECTIVES: To improve the mental health (MH) referral process for children referred from primary care to community mental health clinics (CMHCs) by using a community-partnered approach.METHODS: Our partners were a multisite federally qualified health center and 2 CMHCs in Los Angeles County. We randomly assigned 6 federally qualified health center clinics to the intervention or as a control and implemented a newly developed telehealth-enhanced referral process (video orientation to the CMHC and a live videoconference CMHC screening visit) for all MH referrals from the intervention clinics. Our primary outcome was CMHC access defined by completion of the initial access point for referral (CMHC screening visit). We used multivariate logistic and linear regression to examine intervention impact on our primary outcome. To accommodate the cluster design, we used mixed-effect regression models.RESULTS: A total of 342 children ages 5 to 12 were enrolled; 86.5% were Latino, 61.7% were boys, and the mean age at enrollment was 8.6 years. Children using the telehealth-enabled referral process had 3 times the odds of completing the initial CMHC screening visit compared with children who were referred by using usual care procedures (80.49% vs 64.04%; adjusted odds ratio 3.02 [95% confidence interval 1.47 to 6.22]). Among children who completed the CMHC screening visit, intervention participants took 6.6 days longer to achieve it but also reported greater satisfaction with the referral system compared with controls. Once this initial access point in referral was completed, .80% of eligible intervention and control participants (174 of 213) went on to an MH visit.CONCLUSIONS: A novel telehealth-enhanced referral process developed by using a communitypartnered approach improved initial access to CMHCs for children referred from primary care.

Use of Technology to Promote Child Behavioral Health in the Context of Pediatric Care: A Scoping Review and Applications to Low- and Middle-Income Countries

“…We did not include messaging/texting in the review because evidence suggests effective public health approaches to child mental health intervention require consideration of multicomponent interventions (e.g., including multiple domains of mental health knowledge, skill training, and practice support in parenting/child/health-worker interventions) (36–38). However, existing messaging/texting strategies tend to be used as support or enhancement strategies for interventions, and might be limited in serving as stand-alone mental health intervention strategies in multicomponent interventions (39–41). Finally, many adults and parents in LMICs have low literacy (primary or less than primary school education) and do not have smartphones, which make a messaging approach challenging.…”

Telemedicine in Pediatrics: Systematic Review of Randomized Controlled Trials (Preprint)

“…Afterward, 9 articles were excluded. A total of 11 articles were included in this review [39][40][41][42][43][44][45][46][47][48][49]. The reasons for excluding full-text articles are stated in the PRISMA study flowchart (Figure 1).…”

“…The characteristics of all included studies are reported in Tables 1 and 2. The studies in this review involved a broad range of health conditions, including asthma (2/11, 18%) [46,47], obesity (3/11, 27%) [40,41,44], mental health conditions (1/11, 9%) [48], otitis media (1/11, 9%) [49], skin conditions (1/11, 9%) [43], type 1 diabetes (1/11, 9%) [42], attention deficit hyperactivity disorder (ADHD) (1/11, 9%) [45], and cystic fibrosis-related pancreatic insufficiency (1/11, 9%) [39]. Of the 11 included studies, 9 (82%) were conducted in the United States of America [39][40][41][43][44][45][46][47][48], 1 (9%) was conducted in Italy [42], and 1 (9%) was conducted in Finland [49].…”

Policy Recommendations to Promote Integrated Mental Health Care for Children and Youth

“… 38 , 70 Exploration of novel uses of eHealth for providing integrated care services, including expanded use of telemedicine, the use of follow-up text messages and other modalities to prolong the impact of brief in-person mental health interventions, and the integration of on-line treatments for parents and other caregivers into services based in pediatrics. 71 , 72 Development of efficient training and ongoing support programs for community health workers, peer navigators, and others who can both extend the mental health workforce and increase its capacity for providing care in diverse languages and from diverse cultural perspectives. 73 , 74 Studying processes related to practice transformation and interaction across systems, 75 with particular focus on 1) methods for including diverse families in the design and adaptation process of interventions, 76 and 2) efficient methods for providing initial and long-term assistance to practices and systems as they implement and refine integrated care.…”

“…Exploration of novel uses of eHealth for providing integrated care services, including expanded use of telemedicine, the use of follow-up text messages and other modalities to prolong the impact of brief in-person mental health interventions, and the integration of on-line treatments for parents and other caregivers into services based in pediatrics. 71 , 72 …”