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

NCT02396576 | Completed

• 1 other identifier: IH-12-11-4168
• Study Type: interventional
• Target: 359
• Locations: 1 country
• Sites: 6

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.

Conditions

Developmental, Behavioral and Mental Health; Adhd; Depression; Anxiety; Developmental Delay; Autism; Behavioral Problems

Outcome Measures

Primary Outcomes (5)

• Access to specialty services- Referral time

  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.

  6 month post-enrollment

• Access to specialty services- Travel

  Parent reported number of miles traveled and commute time to initial visit as reported by parents on 6 month post-enrollment survey.

  6 month post-enrollment

• Access to specialty services- Missed school/work

  Parent reported number of days missed from school/work as reported by parents on 6 month post-enrollment survey.

  6 month post enrollment

• Access to specialty services- Out of pocket cost

  Parent reported amount of money spent for daycare and specialty services as reported by parents on 6 month post-enrollment survey.

  6 month post-enrollment

• Access to specialty services- Visits

  Number of specialty visits attended as reported by parents on 6 month post-enrollment survey.

  6 month post-enrollment

Secondary Outcomes (4)

• Quality of care measures

  6 month post-enrollment

• Child Behavior measures

  6 month post-enrollment

• Provider coordination- Communication

  6 month post-enrollment

• Provider coordination- Comfort level

  6 month post-enrollment

Study Arms (2)

Usual Care

NO INTERVENTION

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.

Telehealth Intervention

EXPERIMENTAL

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

Interventions

Telehealth Intervention BEHAVIORAL

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.

Telehealth Intervention

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• 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

You may not qualify if:

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

Sponsors & Collaborators

• University of California, Los Angeles: lead
• Patient-Centered Outcomes Research Institute: collaborator

Study Sites (6)

Northeast Valley Health Corporation- Canoga Park

Canoga Park, California, 91303, United States

Location

Northeast Valley Health Corporation- Pacoima

Pacoima, California, 91331, United States

Location

Northeast Valley Health Corporation- San Fernando

San Fernando, California, 91340, United States

Location

Northeast Valley Health Corporation- Santa Clarita

Santa Clarita, California, 91351, United States

Location

Northeast Valley Health Corporation- Valencia

Valencia, California, 91355, United States

Location

Northeast Valley Health Corporation- Van Nuys

Van Nuys, California, 91405, United States

Location

Related Publications (1)

• Coker TR, Porras-Javier L, Zhang L, Soares N, Park C, Patel A, Tang L, Chung PJ, Zima BT. A Telehealth-Enhanced Referral Process in Pediatric Primary Care: A Cluster Randomized Trial. Pediatrics. 2019 Mar;143(3):e20182738. doi: 10.1542/peds.2018-2738. Epub 2019 Feb 15.

  PMID: 30770523 DERIVED

MeSH Terms

Conditions

Behavior; Psychological Well-Being; Attention Deficit Disorder with Hyperactivity; Depression; Anxiety Disorders; Learning Disabilities; Autistic Disorder; Problem Behavior

Condition Hierarchy (Ancestors)

Personal Satisfaction; Attention Deficit and Disruptive Behavior Disorders; Neurodevelopmental Disorders; Mental Disorders; Behavioral Symptoms; Communication Disorders; Neurobehavioral Manifestations; Neurologic Manifestations; Nervous System Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Autism Spectrum Disorder; Child Development Disorders, Pervasive; Child Behavior

Study Officials

• Tumaini Coker, MD

  University of California, Los Angeles

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Study Record Dates

• First Submitted: March 4, 2015
• First Posted: March 24, 2015
• Study Start: April 7, 2015
• Primary Completion: June 15, 2017
• Study Completion: June 15, 2017
• Last Updated: August 10, 2017

Record last verified: 2017-08

Locations

US (6)