Delivery of Mental Health Services to Children in Underserved Areas

When Tumaini Coker, MD, MBA, began her PCORI-funded project, she knew that multiple barriers stand between children from low-income families and needed mental health services. What she didn’t know was that the barriers vary from stakeholder to stakeholder.

Image

“Pediatricians, parents, and mental healthcare providers all had different ideas of what the barriers were,” says Coker, who is the principal investigator of the project at Seattle Children’s Hospital and Research Center. “At the beginning of the project, our job was to tease out each group’s concerns and try to address them.”

At the academic-community partnership meetings, the pediatricians described their own lack of comfort in managing mental health problems. In contrast, parents had concerns about the mental health clinics and difficulties in completing the clinics’ initial enrollment process. Providers of mental health care reported that they weren’t getting the support they needed in transferring care back to pediatricians for continued management of children’s mental health condition.

In response, the study team decided on a two-pronged approach. The first addresses the intake process at mental health clinics. The study compares the current process—which starts with a phone interview with no support—and a novel process in which parents are guided by a coordinator using videoconferencing. The parents can see the person asking the questions, to increase their comfort level in providing personal information and committing their child to therapy.

The second part of the project is geared to pediatricians, with the research team and the clinic partners working together to develop an online course led by a psychiatrist on best practices in treating children with mental health issues.

Jump-Starting the Study

Partners on this project include pediatricians and other staff at six primary care sites of the Northeast Valley Health Corporation, and mental health specialists at two community mental health centers. These organizations all serve uninsured and medically underserved families from California’s San Fernando and Santa Clarita Valleys.

A working group with parents of patients referred by Northeast Valley Health Corporation pediatricians to mental health clinics, researchers, community mental health clinic psychiatrists, therapists, and staff, and Northeast Valley Health Corporation pediatricians and staff proved key in developing the project, Coker says. For example, through these sessions, the team identified problems in connecting families with the community pediatric mental health clinics, especially when parents did not have a clear understanding of the services provided by those clinics.

“The Latina families told us that they were very uncomfortable receiving calls from the mental health clinic when they didn’t know who the callers were,” says Alpa Patel, MD, a psychiatrist and director of psychiatry services at one of the community mental health clinics in the San Fernando Valley, the Child and Family Guidance Center. “During the phone screen process, the families were asked very intimate questions about insurance status, safety issues, and health concerns.”

Claudia Sweener, a parent whose children received services from one of the mental health clinics, recalls the first call from the clinic. “I was shocked and scared when I was told that my kids needed these services,” she says. “To make matters worse, I didn’t know anything about the mental health clinic, and the intake process was very confusing and took about six hours. They asked a lot of personal questions, and filling out all the paperwork was difficult. The whole process was very frustrating.”

Easing the Intake Process for Parents

Stories from parents such as Sweener guided the researchers’ vision for the project. In its first phase, they devised and tested a more parent-friendly approach to intake using telehealth tools.

In this approach, a coordinator set up a video conference call between the parents at the referring clinic and the intake staff member at the mental health center. The coordinator guided the parents during the call. The intake staff member also showed the parents a video, created by the academic-community research team, providing information about the mental health center.

“What was key was establishing the parents’ comfort level with the process,” Patel says.

Providing Support for the Professionals

The second aspect of the program responds to pediatricians’ lack of training in resuming care for children after they are discharged from the mental health clinic. “To address their concerns, we set up online training sessions,” Coker explains. “We talked about such issues as attention deficit/hyperactivity disorder, depression, and medication management.

“Importantly, we also established lines of communication between the pediatricians and the mental health providers, so that the pediatricians had someone to turn to if they had questions or needed help,” Coker says. The team is testing whether the online training is better than usual care at providing families initial access to services and at helping clinicians coordinate, communicate, and collaborate.

As a parent, Sweener is pleased that the medical professionals took her concerns seriously and are working to improve the intake process. Even with her family’s bumpy start, Sweener is grateful for the mental health care her children received, especially the family sessions. “My kids loved going there,” she says. “My kids have completed their therapy and are doing really well now.”   

The research team feels that they are helping other families to achieve such satisfaction with care. “Although the barriers are significant, the solutions may turn out to be simple,” concludes Patel. “Figuring out ways to give parents confidence in the process, and pediatricians access to additional information as needed, may make all the difference.”

Return to the main page: Can Telehealth Improve Care?
Read: Encouragement for Diabetes Self-Management

Posted: September 25, 2017