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What was the research about?

Nearly 80 percent of children who have Medicaid and mental health problems don’t get the care they need. To begin care, families must go through a complex referral process that can be hard for them to finish.

In this study, the research team developed a video chat referral process to help families with children who have Medicaid get mental health care. In this new process, health centers took a more active role in helping families start the referral process. The team wanted to learn if more families got through the referral process after video chat referrals than families who had usual referrals.

What were the results?

Compared with parents who had usual referrals, those who had video chat referrals were three times more likely to finish screening for mental health care. The research team didn’t find differences between the two groups in number of days between referral and screening or how many families had initial visits at the mental health clinic. After screening, more than 80 percent of families who qualified in both types of referrals had a visit at the mental health clinic.

Parents who had video chat referrals were more likely to say their doctors kept families informed and involved them in their care. They were also more satisfied with their referral process and overall care. The research team didn’t find a difference between the two groups in quality of life related to health.

Who was in the study?

The study included 342 parents of children ages 5 to 12 who had Medicaid. Families in the study lived in Los Angeles County, California. The children received care at one of six health centers. They received a referral to one of two mental health clinics. The health centers and mental health clinics serve a large population of families with low incomes. The average age of children was nine. Among the parents, 87 percent were Hispanic, 7 percent were white, and 2 percent were black. Most parents (96 percent) were women.

What did the research team do?

The research team assigned three clinics by chance to use video chat referrals and three clinics to continue their usual referral process. Video chat referral had these steps:

• Either at the health center or later on their phones, parents watched a five-minute video about the mental health clinic.
• Parents scheduled video chat referral appointments during their health center visit.
• Parents met with a video chat care coordinator at the health center and had a video chat with a screener at the mental health clinic.
• During the video chat, the screener asked parents questions to see if their child qualified for mental health care.
• If their child qualified, parents scheduled a two-hour visit at the mental health clinic.

The usual referral process had these steps:

• Staff at the health center faxed a referral form to screeners at the mental health clinic.
• Screeners called parents and asked questions to see if their child qualified for mental health care.
• If their child qualified, parents scheduled a two-hour visit at the mental health clinic.

Parents took surveys about the referral process and their child’s care at the start of the study and three and six months after their referral.

Mental health doctors, staff members, and parents gave input on the research and helped the research team design the study.

What were the limits of the study?

The research team designed the study to meet the needs of one specific health system. Other health systems might not be able to use the same process.

Future research could study how the process affects long-term mental health care. Researchers could also test video chat referrals in different health systems.

How can people use the results?

Healthcare systems could think about using video chat referrals when they are looking at ways to help families with Medicaid get needed mental health services for their children.

Objective

To test the effectiveness of a telehealth-based referral process, compared with usual referrals, in improving access to mental health care for children with Medicaid

Study Design

In this study, researchers developed a telehealth referral process designed to improve the mental health referral and care coordination process for children. Researchers partnered with six sites that are part of a federally qualified health center and two community mental health clinics in Los Angeles County, California. The health center and community mental health clinics serve a large population of families with low incomes.

Researchers randomly assigned three health center sites to implement the telehealth referral process and three sites to continue their usual referral process. Telehealth referrals included the following steps:

• Parents watched a five-minute video introduction to the mental health clinic either at the health center or later on their phones.
• Parents scheduled telehealth referral appointments during their health center visit.
• At the appointments, parents met with a telehealth care coordinator.
• Through live videoconference, parents connected with the screening department at the mental health clinic.
• Screeners interviewed parents to determine the family’s eligibility for mental health care.
• If their child qualified, parents scheduled a two-hour intake visit at the mental health clinic.

The health center’s usual referral process included the following steps:

• Staff at the health center faxed a referral form to the screening department at the mental health clinic.
• Screeners contacted and interviewed parents by phone to determine the family’s eligibility for mental health care.
• If their child qualified, parents scheduled a two-hour intake visit at the mental health clinic.

The study included 342 parents of children ages 5–12 who had Medicaid insurance. The average age of children was nine. Among the parents, 87% were Hispanic, 7% were white, and 2% were black. Most parents (96%) were female.

Parents completed surveys at study enrollment and then three and six months after their initial referral.

Clinicians, staff members, and parents provided input on the research questions, study design, and study outcomes.

Results

Compared with parents who received usual referrals, those who received telehealth referrals were more likely to complete eligibility screening (odds ratio=3.02; 95% confidence interval: 1.47, 6.22; p<0.05). Researchers did not find differences between the two groups in the number of days between referral and screening or intake visit completion. After they completed eligibility screening, more than 80% of eligible patients in both groups went on to a mental health visit.

Parents who received telehealth referrals were more likely to report receiving family-centered care and had higher mean satisfaction scores with the referral system and overall care (all p<0.05) compared with those who received usual referrals. For health-related quality of life, researchers did not find differences between the two groups.

Limitations

Researchers designed the intervention specifically for the health center and mental health clinics in this study. The approach may not apply to other locations or healthcare settings.

Conclusions and Relevance

Compared with usual referral processes, the telehealth referral process in this study improved eligibility screening completion for mental healthcare services for families with low incomes.

Future Research Needs

Researchers could examine longer term outcomes, such as completion of mental health services. Future research could also test the telehealth referral process in other locations or healthcare settings.