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Pediatrics. 2019 Mar;143(3). pii: e20182738. doi: 10.1542/peds.2018-2738. Epub 2019 Feb 15.

A Telehealth-Enhanced Referral Process in Pediatric Primary Care: A Cluster Randomized Trial.

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Department of Pediatrics, University of Washington School of Medicine, and Seattle Children's Research Institute, Seattle, Washington;
University of California, Los Angeles Mattel Children's Hospital, Los Angeles, California.
Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California.
Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California.
Homer Stryker M.D. School of Medicine, Western Michigan University, Kalamazoo, Michigan.
Northeast Valley Health Corporation, San Fernando, California.
Child and Family Guidance Center, Northridge, California; and.
Kaiser Permanente School of Medicine, Pasadena, California.
Departments of Psychiatry and Biobehavioral Sciences and.


: media-1vid110.1542/5984243450001PEDS-VA_2018-2738Video Abstract OBJECTIVES: To improve the mental health (MH) referral process for children referred from primary care to community mental health clinics (CMHCs) by using a community-partnered approach.


Our partners were a multisite federally qualified health center and 2 CMHCs in Los Angeles County. We randomly assigned 6 federally qualified health center clinics to the intervention or as a control and implemented a newly developed telehealth-enhanced referral process (video orientation to the CMHC and a live videoconference CMHC screening visit) for all MH referrals from the intervention clinics. Our primary outcome was CMHC access defined by completion of the initial access point for referral (CMHC screening visit). We used multivariate logistic and linear regression to examine intervention impact on our primary outcome. To accommodate the cluster design, we used mixed-effect regression models.


A total of 342 children ages 5 to 12 were enrolled; 86.5% were Latino, 61.7% were boys, and the mean age at enrollment was 8.6 years. Children using the telehealth-enabled referral process had 3 times the odds of completing the initial CMHC screening visit compared with children who were referred by using usual care procedures (80.49% vs 64.04%; adjusted odds ratio 3.02 [95% confidence interval 1.47 to 6.22]). Among children who completed the CMHC screening visit, intervention participants took 6.6 days longer to achieve it but also reported greater satisfaction with the referral system compared with controls. Once this initial access point in referral was completed, >80% of eligible intervention and control participants (174 of 213) went on to an MH visit.


A novel telehealth-enhanced referral process developed by using a community-partnered approach improved initial access to CMHCs for children referred from primary care.


Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

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