Final Research Report

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PCORI Stories

Delivery of Mental Health Services to Children in Underserved Areas
A feature story about this study, which is testing whether telehealth helps children from low-income families get the mental health services they need.

Journal Citations

Article Highlight: Many children who are Medicaid participants with mental health problems don’t receive the care they need, in part because families must first undergo a complex referral process to community mental health clinics (CMHCs) for diagnostic and therapeutic mental health services. In this study, highlighted in Pediatrics, researchers used a community-partnered approach to develop a new system of video chat referrals in which health centers took an active role in the referral process to improve families’ initial access to CMHCs for children referred from primary care. Compared with parents who had usual referrals, those who had video chat referrals were three times more likely to finish screening for specialty mental health care at the CMHC. The study is also the subject of a related commentary.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented, and the researchers made changes or provided responses. The comments and responses included the following:

  • Reviewers asked why the effect of telehealth services on referral processes was the only variable tested despite researchers acknowledging that telehealth services could affect other factors as well, such as provider-to-provider communication and parent education. The researchers said they engaged with patient partners and local stakeholders to select the metric they thought would be most helpful to their community.
  • Reviewers noted that the study population of 87 percent Latino patients was not broadly representative, and they asked whether the researchers collected data on some of the cultural issues that might impact treatment effects, such as legal status. The researchers explained that the largely Latino population reflected the population served in the community clinic where the study was conducted, and legal status was too intrusive an issue to collect in the community.
  • Reviewers noted that the study did not assess whether mental health therapy improved outcomes in the children studied. The researchers responded that the six-month follow-up period of the study could not address this question given the shortage of providers and long waiting lists in this community healthcare setting.
  • Reviewers suggested that the tested intervention could be replicated with referrals from federally qualified health centers and community mental health clinics but that it may not work as well in other types of primary care centers because of different cost structures related to the need for a telehealth coordinator. The researchers agreed that a full cost analysis would be an important next step in this research to determine whether the intervention could be replicated in primary care centers with differing cost structures.

Conflict of Interest Disclosures

Project Information

Tumaini Coker, MD, MBA
Seattle Children's Research Institute^
$1,715,453
10.25302/8.2019.IH.12114168IC
Using Telehealth to Deliver Developmental, Behavioral, and Mental Health Services in Primary Care Settings for Children in Underserved Areas

Key Dates

May 2013
December 2018
2013
2018

Study Registration Information

^Tumaini Coker, MD, MBA, was affiliated with University of California, Los Angeles when this project was funded.

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Last updated: March 4, 2022