A trial of telephone services to increase adolescent utilization of health care for psychosocial problems

Abstract

Purpose: Adolescents identified in primary care clinics as experiencing psychosocial problems frequently do not receive recommended referral mental health care services. The purpose of the present study was to test whether a Telephone Support Services (TSS) intervention would increase subsequent healthcare utilization. Our TSS intervention featured a combination of case management and motivational interviewing.

Method: One hundred seventy-nine adolescents who screened positive for at least one of three psychosocial problems--depressive symptoms, suicidal ideation, or substance use--were randomly assigned to one of two study conditions. Eighty-nine participants were randomly assigned to TSS, and 90 participants were assigned to Enhanced Usual Care (UC+). Adolescents completed self-report interviews of medical and mental health utilization at 4 months. In addition, research staff queried our hospital's administrative data warehouse to obtain each participant's medical service and mental health service use at 6 months.

Results: TSS did not increase subsequent utilization of either medical or mental health services for adolescents screening positive for psychosocial problems in a primary care clinic. This finding held true whether service utilization was assessed through self-report or administrative data.

Discussion: The lack of experimental effect on healthcare utilization suggests that certain aspects of our TSS require modification in future work. On a positive note, given that each of the three TSS calls was completed by a strong majority of participants, TSS appears feasible and acceptable to adolescents with psychosocial problems.