Timely Access to Mental Health Services for Patients with Pain

Abstract

Introduction: Efficient access to pediatric mental health services is a growing concern as the number of patients increases and outpaces efforts to expand services. This study outlines interventions implemented using quality improvement (QI) science and methodology to demonstrate how a clinic embedded in a large children’s hospital can improve access to the first appointment for a population seeking pain management services. Methods: A process improvement project started with a QI team, whose members designed interventions to change scheduling practices. Initial changes involved decreased time between calls to families, and efforts to streamline notifications among clinicians. Additional interventions included a close examination of waitlist assignment based on appropriateness and assessing patient interest in treatment. Results: Within 3 months of implementation, a significant decline in wait time occurred for patients seeking services for pain management, from 106 to 48 days. This change remained stable for 6 months. In light of a sharp increase in referrals and wait time during the study period, efforts to engage additional clinicians in managing referrals resulted in wait time to stabilize at an average of 63 days to the first appointment. This change remained for 10 months. Scheduling changes did not negatively affect other providers. Conclusions: This study demonstrates the application of QI science to improve patient access to mental health care. Future directions will focus on enhancing the use of the electronic health record, along with previsit family engagement.

Service redesign interventions to reduce waiting time for paediatric rehabilitation and therapy services: A systematic review of the literature

“…Process efficiency or pathway interventions used a variety of strategies to improve patient flow, such as elements of lean thinking approaches, changes to referral criteria, new patient pathways and changes to the model of care such as increased use of groups. There were 11 studies in this category (Table 2 ), including three in autism services (Austin et al, 2016 ; Lemay et al, 2018 ; Rutherford et al, 2018 ), two in occupational therapy services (Horton & Hall, 2008 ; F. Millar et al, 2013 ), four in mental health (Butz et al, 2019 ; Rocks et al, 2020 ; Wenning & King, 1995 ; Woodhouse, 2006 ) and one each in early intervention(Bell et al, 2010 ) and general rehabilitation (Camden et al, 2013 ). All but one (Rocks et al, 2020 ) reported reductions in waiting time (Figure 2b ), with eight of these cases being reductions of more than 50%.…”

“…Rates of missed appointments were reported in two studies using rapid response interventions (Clemente et al, 2006 ; Evans, 2014 ) and two studies using process redesign interventions (Butz et al, 2019 ; Woodhouse, 2006 ). Both reported reductions in the proportion of people who missed appointments.…”

“…Three studies evaluated agreement between specialists and alternative providers making diagnostic decisions in substitution interventions, and all reported moderate‐to‐high agreement between clinicians (Ahlers et al, 2019 ; Choueiri et al, 2021 ; McClure et al, 2010 ). Finally, two process redesign studies reported the intervention to be associated with increased use of groups (Bell et al, 2010 ; Camden et al, 2013 ), two reported increases in patients seen post intervention (Bell et al, 2010 ; Lynch & Hedderman, 2006 ) and one checked for any adverse impacts of scheduling changes for other service providers not involved in the intervention but found no effect (Butz et al, 2019 ).…”

“…(Horton & Hall, 2008;F. Millar et al, 2013), four in mental health (Butz et al, 2019;Rocks et al, 2020;Wenning & King, 1995;Woodhouse, 2006) and one each in early intervention (Bell et al, 2010) and general rehabilitation (Camden et al, 2013). All but one (Rocks et al, 2020) reported reductions in waiting time (Figure 2b), with eight of these cases being reductions of more than 50%.…”

Supporting Students’ Mental Health Needs: A Primer for Secondary School Leaders

“…Unfortunately, access to mental health care is difficult for many of our youth (Butryn et al, 2017). There is a shortage of community mental health providers, and the wait time for an appointment is an average of 106 days (Cama et al, 2017; Butz et al, 2019). There are further disparities in access to mental health care among youth of color, youth with severe emotional and behavioral disabilities, and among families living in poverty (American Psychological Association, 2017; Alegria et al, 2015; Inkelas et al, 2007; Stiffman et al, 2004).…”