Abstract
Publicly insured children needing referral to mental health (MH) services often do not access or receive services. The objective of this study was to identify gaps in communication and coordination between primary care providers (PCPs) and MH providers during the MH referral and care process for publicly insured children. Thirteen semi-structured interviews were conducted with 10 PCPs and staff from a federally qualified health center (FQHC) and 6 MH providers and staff from two local MH clinics. Interview participants identified multiple gaps in communication throughout the care process and different phases as priorities for improvement. PCPs described primary care-MH communication challenges during early phases, while MH providers described coordination challenges in transferring patients back to primary care for ongoing mental health management. Strategies are needed to improve primary care-specialty MH communication and coordination throughout all phases of the referral and care process, particularly at initial referral and transfer back to primary care.
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Abbreviations
- MH:
-
Mental health
- FQHC:
-
Federally qualified health center
References
California Department of Health Care. MCMHP Consolidation and Managed Care. California Department of Health Care. Available online at http://www.dhcs.ca.gov/services/mh/Pages/MCMHP-Consolidation.aspx. Accessed on April 28, 2016.
Children's Defense Fund. The Barriers. Why is So Difficult for Children to Get Mental Health Screens and Assessments? Children's Defense Fund. Available online at http://www.childrensdefense.org/library/data/barriers-children-mental-health-screens-assesments.pdf. Accessed on April 28, 2016.
Asarnow JR, Rozenman M, Wiblin J, et al. Integrated Medical-Behavioral Care Compared With Usual Primary Care for Child and Adolescent Behavioral Health. Journal of the American Medical Association Pediatrics 2015;169(10):929–937.
Olfson M. Evaluating the Quality of Community Care for Attention-Deficit/Hyperactivity Disorder. Journal of the American Academy of Child & Adolescent Psychiatry 2010;49(12):1183–1185.
Sarvet B, Gold J, Bostic JQ, et al. Improving Access to Mental Health Care for Children: The Massachusetts Child Psychiatry Access Project. Pediatrics 2010;126(6):1191–1200.
Gruttadaro D, Markey D. Integrating Mental Health and Pediatric Primary Care. National Alliance on Mental Illness. Available online at https://www.integration.samhsa.gov/integrated-care-models/FG-Integrating,_12.22.pdf. Accessed on April 28, 2016.
Williams J, Shore SE, Foy JM. Co-location of Mental Health Professionals in Primary Care Settings: Three North Carolina Models. Clinical Pediatrics 2006;45(6):537–543.
Ford J, Steinberg K, Pidano A, et al. Behavioral Health Services in Pediatric Primary Care: Meeting the Needs in Connecticut. Child Health and Development Institute of Connecticut, Inc. Available online at https://www.chdi.org/index.php/publications/reports/other/behavioral-health-services-pediatric-primary-care-meeting-needs-connecticut. Accessed on April 28, 2006.
Francis JJ, Johnston M, Robertson C, et al. What is an Adequate Sample Size? Operationalising Data Saturation for Theory-based Interview Studies. Psychology & Health 2010;25(10):1229–1245.
Fassinger RE. Paradigms, Praxis, Problems, and Promise: Grounded Theory in Counseling Psychology Research. Journal of Counseling Psychology 2005;52(2):156–166.
Mooney K, Moreno C, Chung PJ, et al. Well-Child Care Clinical Practice Redesign at a Community Health Center: Provider and Staff Perspectives. Journal of Primary Care & Community Health 2014;5(1):19–23.
Coker TR, DuPlessis HM, Davoudpour R, et al. Well-Child Care Practice Redesign for Low-Income Children: the Perspectives of Health Plans, Medical groups, and State Agencies. Pediatrics 2012;12(1):43–52.
Thomas J, Harden A. Methods for the Thematic Synthesis of Qualitative Research in Systematic Reviews. BioMed Central Medical Research Methodoly 2008;8:45.
Malterud K. Qualitative Research: Standards, Challenges, and Guidelines. Lancet 2001;358(9280):483–488.
Maxwell JA. Qualitative Research Design : An Interactive Approach. Thousand Oaks, California: SAGE Publications; 2013.
Ryan GW, Bernard HR. Data management and analysis methods In: NK Denzin, YS Lincoln (Eds). Handbook of Qualitative Research, Second Edition. Thousand Oaks, California: Sage Publications; 2000, pp.769–802.
Mehrotra A, Forrest CB, Lin CY. Dropping the Baton: Specialty Referrals in the United States. The Milbank Quarterly 2011;89(1):39–68.
Naseriasl M, Adham D, Janati A. E-referral Solutions: Successful Experiences, Key Features and Challenges—a Systematic Review. Materia Socio-Medica 2015;27(3):195–199.
Song Z, Sequist TD, Barnett ML. Patient Referrals—a Linchpin for Accountable Care. Journal of the American Medical Association 2014;312(6):597–598.
Straus SG, Chen AH, Yee H, et al. Implementation of an Electronic Referral System for Outpatient Specialty Care. AMIA Annual Symposium Proceedings Archive 2011;2011:1337–1346.
Hobbs Knutson K, Masek B, Bostic JQ, et al. Clinicians’ Utilization of Child Mental Health Telephone Consultation in Primary Care: Findings from Massachusetts. Psychiatric Services 2014;65(3):391–394.
Mandros A. Medicaid Behavioral Health Carve-Outs - 11 Remain. Available online at https://www.openminds.com/market-intelligence/executive-briefings/are-we-watching-the-demise-of-the-behavioral-health-carve-out/. Accessed October 19, 2017.
Blount A. Integrated primary care: Organizing the Evidence. Families, Systems, & Health 2003;21(2):121–133.
Funding Sources
This work was supported through a Patient-Centered Outcomes Research Institute (PCORI) Award (IH-12-11-4168) and a grant from the California Community Foundation (CCF) Award (BAPP-14-107,111). All statements in this report, including its findings and conclusions, are solely those of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors or Methodology Committee.
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Porras-Javier, L., Bromley, E., Lopez, M. et al. Challenges to Effective Primary Care-Specialty Communication and Coordination in the Mental Health Referral and Care Process for Publicly Insured Children. J Behav Health Serv Res 45, 668–677 (2018). https://doi.org/10.1007/s11414-018-9585-z
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DOI: https://doi.org/10.1007/s11414-018-9585-z