Using Telehealth to Deliver Mental Health Services in Primary Care Settings for Children in Underserved Areas
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|ClinicalTrials.gov Identifier: NCT02396576|
Recruitment Status : Completed
First Posted : March 24, 2015
Last Update Posted : August 10, 2017
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.
|Condition or disease||Intervention/treatment||Phase|
|Developmental, Behavioral and Mental Health Adhd Depression Anxiety Developmental Delay Autism Behavioral Problems||Behavioral: Telehealth Intervention||Not Applicable|
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||359 participants|
|Intervention Model:||Parallel Assignment|
|Masking:||None (Open Label)|
|Primary Purpose:||Health Services Research|
|Official Title:||Using Telehealth to Deliver Mental Health Services in Primary Care Settings for Children in Underserved Areas|
|Actual Study Start Date :||April 7, 2015|
|Actual Primary Completion Date :||June 15, 2017|
|Actual Study Completion Date :||June 15, 2017|
No Intervention: 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.
Experimental: 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.
Behavioral: Telehealth Intervention
The telehealth model will integrate developmental, behavioral, (DB) and mental health services (MH) into pediatric primary care using videoconferencing that will be tested with children in low-income, urban communities.
- 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- 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- 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- Visits [ Time Frame: 6 month post-enrollment ]Number of specialty visits attended as reported by parents on 6 month post-enrollment survey.
- Quality of care measures [ Time Frame: 6 month post-enrollment ]Parent reported quality of care measures as measured by the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician and Group Survey. Three measures will be utilized from CAHPS; 1.Timely Appointment, Care and Information, 2. Providers Communication with Patients, and 3. Patients' Rating of Providers.
- Child Behavior measures [ Time Frame: 6 month post-enrollment ]Parent reported child behavior as measured by Pediatric Quality of Life (PedsQL), and Pediatric Symptom Checklist.
- Provider coordination- Communication [ Time Frame: 6 month post-enrollment ]Provider reported level of communication between PCP and specialists as measured by the communication measure from the California Mental Health Services Authority Integrated Behavior Health Care (IBHC).
- Provider coordination- Comfort level [ Time Frame: 6 month post-enrollment ]Provider reported comfort level of diagnosis, medication initiation, medication management, and patient monitoring as reported by providers on 6 month post-enrollment survey.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02396576
|United States, California|
|Northeast Valley Health Corporation- Canoga Park|
|Canoga Park, California, United States, 91303|
|Northeast Valley Health Corporation- Pacoima|
|Pacoima, California, United States, 91331|
|Northeast Valley Health Corporation- San Fernando|
|San Fernando, California, United States, 91340|
|Northeast Valley Health Corporation- Santa Clarita|
|Santa Clarita, California, United States, 91351|
|Northeast Valley Health Corporation- Valencia|
|Valencia, California, United States, 91355|
|Northeast Valley Health Corporation- Van Nuys|
|Van Nuys, California, United States, 91405|
|Principal Investigator:||Tumaini Coker, MD||University of California, Los Angeles|