Using Telehealth to Deliver Mental Health Services in Primary Care Settings for Children in Underserved Areas
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Enrollment
- 359
- Locations
- 12
- Primary Endpoint
- Access to specialty services- Missed school/work
Study Overview
Brief Summary
In partnership with a multi-site, Los Angeles-area community clinic consortium, North East Valley Health Corporation (NEVHC), the investigators will use telehealth to integrate pediatric developmental, behavioral and mental health (DB/MH) services into primary care for low-income, publicly insured children. During Project Year 1, the investigators used qualitative methods to conduct and analyze interviews with parents, clinicians, and staff at NEVHC to assess their perspectives on the delivery of child DB/MH services and on a potential telehealth-based patient visit, coordination, and clinician education system for the provision of DB/MH specialty care in primary care settings to children ages 5-12. This data was used in a stakeholder-engaged process to customize a telehealth-based delivery system for pediatric DB/MH services that can be integrated into primary care settings.
During Project Years 2-3, the investigators will conduct a cluster randomized controlled trial (RCT) to compare the customized telehealth-based patient visit, coordination, and clinician education system to the usual in-person, community- based referral system at NEVHC. This study will examine whether a telehealth developmental, behavioral and mental health delivery model can be an effective, efficient, and family-centered way to provide integrated DB/MH services to children in low-income communities.
Detailed Description
There are three main parts to the basic template of this telehealth intervention:
- Real-time videoconference patient visits. Patients who need a specialty visit with a developmental/behavioral pediatrician will be scheduled for a telehealth visit (with the patient at the primary care clinical site and the subspecialists located at a University of California, Los Angeles (UCLA) telehealth site). Patients who need a psych/MH referral will initially connect with the mental health clinic (MHC) via telehealth. Therapy visits and the initial psychiatric assessment for medications are in person. Follow up psychiatric visits are via telehealth.
- Enhanced clinician communication and patient coordination. Providers will use telehealth capabilities to communicate with each other about patient care and coordination issues, including diagnostic decisions, management strategies, and other patient care coordination activities.
- Clinical educational sessions for clinicians. The telehealth equipment will also be used for real-time videoconference educational sessions to help primary care clinicians and specialty care clinicians share knowledge and experience that can translate into greater improvements for patient care.
The investigators will compare the new customized telehealth-based patient visit, coordination, and clinician education system to the usual in-person, community based referral system at NEVHC. Patients scheduled for a telehealth visit will receive a phone reminder 2 days before the visit. The location of the telehealth visit will be at the same clinic location as the index primary care provider (PCP) visit. Upon arrival for their telehealth visit, parents will be sent to a typical patient encounter room at the clinical site. The room will be set up for a telehealth visit with telehealth equipment, two chairs for the parent(s) and a small table with chairs and toys for the child and any siblings that arrive with the family. The camera will be set up to allow the specialty provider to have full view of the examination room. The system uses a multifunctional camera with zoom and pan (side to side) capabilities; the investigators will utilize a high-speed internet connection at NEVHC for optimal connection speed.
A bilingual (Spanish and English) telehealth coordinator will greet the parents and coordinate the visit at the NEVHC end. The telehealth coordinator is present at the NEVHC end of the telehealth visit for the duration of the visit. The telehealth coordinator ensures that the camera and microphones are operating correctly, positions the camera as necessary, conducts a volume and vision check, and as the exam proceeds, provides Spanish language interpretation if necessary.
The clinical encounter proceeds as a typical "in-person" encounter.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Health Services Research
- Masking
- None
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Parent or guardian with child between the ages of 5 to 12
- •Must speak English or Spanish
- •Child has been referred by primary care doctor for mental health or developmental behavioral services
Exclusion Criteria
- •Parent /Guardian under 18 years of age
- •Parent employed by Northeast Valley Health Corporation
Arms & Interventions
Usual Care
NEVHC has two main Department of Mental Health (DMH) contracted clinical partners where the majority of the patients are referred to -these are Child and Family Guidance Center (CFGC) in the San Fernando Valley and Child and Family Center (CFC) in the Santa Clarita Valley.
Telehealth Intervention
The telehealth model will enhance patient coordination as well as clinician communication via live videoconferencing. Developmental behavioral services will be provided by a Developmental Behavioral Pediatrician (DBP) housed at UCLA from Children's Hospital Los Angeles (CHLA). Mental Health services will be provided by Child Family Center (CFC) and Child Family Guidance Center (CFGC). The location of the telehealth visit will be at the same clinic location as the index PCP visit with a telehealth coordinator facilitating the encounter between patient and clinicians.The clinician communication will be enhanced through monthly telehealth topic-based educational sessions as well as case-based educational sessions for the transfer cases.
Intervention: Telehealth Intervention (Behavioral)
Outcomes
Primary Outcomes
Access to specialty services- Missed school/work
Time Frame: 6 month post enrollment
Parent reported number of days missed from school/work as reported by parents on 6 month post-enrollment survey.
Access to specialty services- Out of pocket cost
Time Frame: 6 month post-enrollment
Parent reported amount of money spent for daycare and specialty services as reported by parents on 6 month post-enrollment survey.
Access to specialty services- Travel
Time Frame: 6 month post-enrollment
Parent reported number of miles traveled and commute time to initial visit as reported by parents on 6 month post-enrollment survey.
Access to specialty services- Referral time
Time Frame: 6 month post-enrollment
Referral process from baseline to 6 month post-enrollment. Parent reported time from initial referral to first specialty visit as reported by parents on 6 month post-enrollment survey.
Access to specialty services- Visits
Time Frame: 6 month post-enrollment
Number of specialty visits attended as reported by parents on 6 month post-enrollment survey.
Secondary Outcomes
- Quality of care measures(6 month post-enrollment)
- Provider coordination- Communication(6 month post-enrollment)
- Child Behavior measures(6 month post-enrollment)
- Provider coordination- Comfort level(6 month post-enrollment)
Investigators
Tumaini R Coker
Assistant Professor
University of California, Los Angeles