Results Summary

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.

Final Research Report

View this project's final research report.

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^
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

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: October 18, 2023