As pediatricians, we recognize the need to screen our patients for behavioral, developmental, and mental health issues. Yet if a child screens positive or presents with a mental health concern, treating that concern often requires the assistance of a community referral source. Yet even if you tell your patients to follow-up with a community program outside your office, ensuring a patient will keep that referral appointment is easier said than done. That is where a telehealth link between a pediatric office and a community mental health referral center might improve the chances that the handoff for care will occur. At least, that is what Coker et al. (10.1542/peds.2018-2738) hoped when they designed a randomized trial involving six federally-qualified health center (FQHC) multisite clinics and two community mental health clinics (CHMCs). The investigators randomized these FQHC clinics involving 342 children ages 5-12 years with mental health concerns to either receive a routine referral from office to a CHMC or to be connected via telehealth while in the office to the CHMC for an intake screening visit. The results show that those children who were referred by the medical home while the child was in the FQHC clinic were three times more likely to complete their screening and were much happier to move forward with the official referral than the controls---although both populations once they had been screened did come to the CHMC for a follow-up visit 80% of the time.
So how important is the use of telehealth in helping ensure patients get screened for a mental health referral? We asked Dr. Susan Kressly (10.1542/peds.2018-3765) to weigh in with an accompanying commentary. Dr. Kressly not only praises the authors on this innovative way to ensure adherence with a mental health referral, but also raised the alternative of integrating mental health services directly into the primary care medical home if space is permitting and the business plan for doing so is viable. If not, telehealth might be something to consider if you haven’t already. We would welcome your comments on this study as well as whether you are using or considering using telehealth for your practice. If the latter, are you finding it a benefit to your ability to care for your patients? Share your comments with us by responding to this blog, posting a comment on our website with this article or sharing your thoughts on our Twitter or Facebook sites.