Mattel Children's Hospital UCLA, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Ethn Dis. 2018 Sep 6;28(Suppl 2):457-466. doi: 10.18865/ed.28.S2.457. eCollection 2018.
To develop an intervention to improve the mental health referral and care process for children referred by primary care providers (PCPs) to community mental health clinics (MHCs) using a community partnered approach.
A Project Working Group (PWG) with representatives from each partner organization met monthly for 6 months.
Multi-site federally qualified health center (FQHC) and two community MHCs in Los Angeles county.
26 stakeholders (14 FQHC clinic providers/staff, 8 MHC providers/staff, 4 parents) comprised the PWG.
Qualitative interviews, PWG meeting notes, intervention processes and workflow reports.
The PWG reviewed qualitative data from stakeholders (interviews of 7 parents and 13 providers/staff). The PWG met monthly to identify key transition points where access to and coordination of care were likely compromised and to develop solutions.
Three critical transition points and system solutions were identified: 1) Parents refuse initial referral to the MHC due to stigma regarding mental health services. During initial referral, parents watch a video introducing them to the MHC. 2) Parents don't complete the MHC's screening after referral. A live videoconference session connecting parents at the FQHC with MHC staff ensures completion of the screening and eligibility process. 3) PCPs reject transfer of patients back to primary care for ongoing psychotropic medication management. Regularly scheduled live videoconferences connect PCPs and MHC providers.
A community partnered approach to care design utilizing telehealth for care coordination between clinics can potentially be used to address key challenges in MHC access for children.
采用社区合作的方法，为基层医疗服务提供者（PCP）转介至社区心理健康诊所（MHC）的儿童开发一种改善心理健康转介和护理流程的干预措施。
一个由每个合作伙伴组织的代表组成的项目工作组（PWG）每月开会 6 个月。
洛杉矶县的多个地点联邦合格的健康中心（FQHC）和两个社区 MHC。
26 名利益相关者（14 名 FQHC 诊所提供者/工作人员、8 名 MHC 提供者/工作人员、4 名家长）组成了 PWG。
定性访谈、PWG 会议记录、干预措施流程和工作流程报告。
PWG 审查了利益相关者（对 7 名家长和 13 名提供者/工作人员进行的访谈）的定性数据。PWG 每月开会，确定可能影响获得和协调护理的关键过渡点，并制定解决方案。
确定了三个关键的过渡点和系统解决方案：1）家长由于对心理健康服务的污名化而拒绝初始转介到 MHC。在初始转介时，家长观看介绍 MHC 的视频。2）家长在转介后未完成 MHC 的筛查。通过连接 FQHC 家长和 MHC 工作人员的实时视频会议，确保完成筛查和资格审查过程。3）PCP 拒绝将患者转回初级保健以进行持续的精神药物管理。定期的实时视频会议将 PCP 和 MHC 提供者联系起来。
利用远程医疗进行诊所之间的护理协调，采用社区合作的方法进行护理设计，可能有助于解决儿童 MHC 获得方面的关键挑战。
