Half of all adolescents have mental health disorders and 22% of these are severely impaired by their mental health disorder.1 While an estimated 15 million adolescents need mental health services, only 8,300 child and adolescent psychiatrists practice in the US.2 With limited availability of child mental health specialists, pediatricians and families often struggle to obtain needed mental health care for children. Peters et al (10.1542/peds.2017-2417) recognized a systems failure when only 52% of available appointments with mental health therapists embedded within an adolescent clinic had scheduled appointments.
The early steps of the quality improvement work by Peters et al are important. Convening a multidisciplinary quality improvement team, including all key stakeholders, is key to success. Measurements were identified and statistical process control charts were developed to monitor the problem, and test improvements. These steps are necessary to identify successful and unsuccessful changes to the system and to adopt those changes which are successful.
Improved communication, starting with convening a multidisciplinary team, were also critical to the success of the interventions. The team found that appointment show rates improved with “warm referrals” where the patient and family met with a member of the mental health team in the adolescent clinic during the referral. In addition, appointment reminder calls by staff included motivational interviewing to overcome barriers to treatment. The team found an improvement in the percent of open appointments being filled after implementation of an electronic referral and social work follow up protocol. The social worker assisted patients in scheduling appointments. The successful intervention steps used improved communication, teamwork, and coordination – with some facilitation by technology.
The quality improvement approach used by Peters et al. can be used for any other underutilized resource- for example under-scheduled or missed nutritional appointments for obese patients. This approach may also be of benefit to the many practices having difficulty with access to mental health resources, such as weeks or months until the 3rd next available appointment with a mental health expert. Until longer term solutions to the pediatric mental health crisis can be developed and implemented, quality improvement approaches are useful tools to optimize access to available pediatric mental health services.
References
1. Mental Illness. https://www.nimh.nih.gov/health/statistics/mental-illness.shtml. 2017.
2. Access to Adolescent Mental Health Care. https://www.hhs.gov/ash/oah/adolescent-development/mental-health/access-adolescent-mental-health-care/index.html. HHS.gov, 2018.
