Improving Timely Access to School-Based Mental Health Services: Getting through the Referral Gate. Issue 2 (2nd April 2020)

• Record Type: Journal Article
• Authors: Twymon, Kamilah; Dorsey, Misti; Hudson, Nakeia; Kane, Jennifer; Valleru, Jahnavi; Fristad, Mary A.
• Is Part Of: Evidence-based practice in child and adolescent mental health. Volume 5:Issue 2(2020)
• Page Start: 118
• Page End: 127
• Publication Date: 2020-04-02
• Subjects: Quality improvement -- school-based -- mental health -- intervention -- children; Child psychiatry -- Periodicals; Child mental health -- Periodicals; Teenagers -- Mental health -- Periodicals; Child psychology -- Periodicals; Adolescent psychology -- Periodicals; 618.9289
• DOI: 10.1080/23794925.2020.1784055
• Languages: English
• ISSNs: 2379-4925

Abstract

ABSTRACT: Timely access to mental health and behavioral support services for youth can occur by providing school-based interventions by trained school-based therapists. However, logistical and organizational challenges frequently occur when accepting, managing, and scheduling school-based referrals. Addressing these concerns is essential to sustain funding of partnerships between schools and pediatric health-care providers. Using the Institute of Healthcare Improvement's model of quality improvement, our pediatric academic health center's Behavioral Health team engaged in a quality improvement initiative with the goal of increasing by 50% the proportion of new students scheduled for school-based services within 30 days, from 57% to 85%. An inter-professional team determined causes of poor access, then designed and tested a series of interventions using a Plan-Do-Study-Act strategy to improve the referral process. Standard quality improvement statistical process control charts provided insights into historical performance, variation in current processes, and the impact of interventions on the referral system. Leveraging the electronic medical record to track referral data, creating a new staff role to screen, triage, and schedule referrals, and implementing a referral follow-up process with families significantly improved outcomes. Immediately after implementing initial interventions, the proportion of scheduled referrals increased, reaching and maintaining the goal of 85% within 18 months, despite a 67% increased volume of incoming referrals. Additionally, the average wait time for all scheduled referrals reduced 50%, from 36 days to 18 days. Employing a quality improvement framework guided our team to this sustained improvement in referrals for children in need of school-based services.