Does a Video Chat Referral Process Help Families With Children Who Have Medicaid to Initiate Mental Health Care? [Internet]

Excerpt

Background: Medicaid-insured children who require specialty mental health care can be referred to community mental health clinics (CMHCs), but nearly 80% of children who need mental health services do not receive them.

Objective: To improve the mental health referral process for children referred by primary care providers to CMHCs using a community-partnered approach.

Methods:

1. Design. Cluster randomized trial (April 2015-May 2017) with a 6-month follow-up.

2. Setting. A multisite federally qualified health center (FQHC) and 2 CMHCs in Los Angeles County, California.

3. Participants. Parents of children aged 5 to 12 years who received a recent (≤30 days) referral to 1 of the 2 CMHCs. Of 542 parent–child dyads receiving a referral, 483 were assessed for study eligibility; 342 were enrolled.

4. Intervention. The intervention focused on improving the initial step in the referral process from the FQHC to the CMHC. This first step is the CMHC screening visit, which usually takes place via phone or in person at the CMHC. As part of the intervention, the CMHC screening visit was conducted via a live videoconference with the parent and an FQHC care coordinator connecting from the FQHC to a case manager at the CMHC.

5. Main outcome and measures. CMHC screening visit completion, the initial access point for referral to specialty mental health care. We used adjusted multivariate logistic and linear regression to examine intervention impact. To accommodate the cluster design, we used mixed-effect regression models.

Results: Of 342 children, 86.5% were Latino, 61.7% male, and mean age at enrollment was 8.6 years. Children using the telehealth-coordinated referral process had 3 times the odds of completing the initial CMHC screening visit compared with children referred using usual care procedures (80.49% vs 64.04%; adjusted odds ratio, 3.17; 95% CI, 1.46-6.91). Among children who completed the CMHC screening visit, intervention children took longer (23.69 vs 17.10 days; P = .012) to reach the screening visit. At 6-month follow-up, intervention and control participants did not significantly differ on reported family-centered care (86.3% vs 75.3%; P = .08) or child health–related quality of life, but intervention group participants did report greater satisfaction with the referral process (mean [SD], 8.8 [1.7] vs 7.9 [2.7]; P = .003) compared with control.

Conclusions and Relevance: We developed a novel telehealth-coordinated referral process in partnership with key stakeholders from the FQHC and CMHCs. The intervention improved initial access to CMHCs for children referred from primary care. Future work on how this increased access affects behavioral health outcomes is needed.

Limitations: Our main study limitations include a potential lack of generalizability of the intervention elements to other settings and locations that may have a different referral system.