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Using Telehealth to Deliver Mental Health Services in Primary Care Settings for Children in Underserved Areas

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT02396576
Recruitment Status : Completed
First Posted : March 24, 2015
Last Update Posted : August 10, 2017
Sponsor:
Collaborator:
Patient-Centered Outcomes Research Institute
Information provided by (Responsible Party):
Tumaini R Coker, University of California, Los Angeles

Brief Summary:

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

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 359 participants
Allocation: Randomized
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

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Mental Health

Arm Intervention/treatment
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.




Primary Outcome Measures :
  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.


Secondary Outcome Measures :
  1. 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.

  2. 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.

  3. 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).

  4. 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.



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Parent or guardian with child between the ages of 5 to 12
  • Must speak English or Spanish
  • Child has been referred by primary care doctor for mental health or developmental behavioral services

Exclusion Criteria:

  • Parent /Guardian under 18 years of age
  • Parent employed by Northeast Valley Health Corporation

Information from the National Library of Medicine

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


Locations
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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
Sponsors and Collaborators
University of California, Los Angeles
Patient-Centered Outcomes Research Institute
Investigators
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Principal Investigator: Tumaini Coker, MD University of California, Los Angeles
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Tumaini R Coker, Assistant Professor, University of California, Los Angeles
ClinicalTrials.gov Identifier: NCT02396576    
Other Study ID Numbers: IH-12-11-4168
First Posted: March 24, 2015    Key Record Dates
Last Update Posted: August 10, 2017
Last Verified: August 2017
Additional relevant MeSH terms:
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Problem Behavior
Behavioral Symptoms