Department of Pediatrics, University of Washington School of Medicine, and Seattle Children's Research Institute, Seattle, Washington;
University of California, Los Angeles Mattel Children's Hospital, Los Angeles, California.
Pediatrics. 2019 Mar;143(3). doi: 10.1542/peds.2018-2738. Epub 2019 Feb 15.
: media-1vid110.1542/5984243450001PEDS-VA_2018-2738 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.
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.
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.
A novel telehealth-enhanced referral process developed by using a community-partnered approach improved initial access to CMHCs for children referred from primary care.
通过采用社区合作伙伴关系的方法，改善从初级保健机构转介到社区心理健康诊所（CMHC）的儿童的心理健康（MH）转介流程。
我们的合作伙伴是洛杉矶县的一个多地点联邦合格的健康中心和 2 个 CMHC。我们将 6 个联邦合格的健康中心诊所随机分配到干预组或对照组，并为干预诊所的所有 MH 转介实施了新开发的远程医疗增强型转介流程（CMHC 视频介绍和现场视频会议 CMHC 筛查访问）。我们的主要结果是通过完成转介的初始接入点（CMHC 筛查访问）来定义 CMHC 接入。我们使用多变量逻辑回归和线性回归来检查干预对我们主要结果的影响。为了适应聚类设计，我们使用了混合效应回归模型。
共纳入 342 名 5 至 12 岁的儿童；86.5%是拉丁裔，61.7%是男孩，入组时的平均年龄为 8.6 岁。与采用常规护理程序转介的儿童相比，使用远程医疗增强型转介流程的儿童完成初始 CMHC 筛查访问的可能性高 3 倍（80.49%比 64.04%；调整后的优势比 3.02[95%置信区间 1.47 至 6.22]）。在完成 CMHC 筛查访问的儿童中，干预组完成该访问的时间延长了 6.6 天，但与对照组相比，他们对转介系统的满意度更高。一旦完成了转介的初始接入点，>80%的符合条件的干预组和对照组参与者（174 名中的 213 名）接受了 MH 访问。
通过采用社区合作伙伴关系的方法开发的一种新颖的远程医疗增强型转介流程，改善了从初级保健机构转介的儿童对 CMHC 的初始访问。
