An Electronic Referral and Social Work Protocol to Improve Access to Mental Health Services

The prevalence of mental health problems among adolescents in the United States is a major public health concern. However, the uptake of mental health treatment is low. Integrating behavioral health into primary care is 1 research-informed strategy to increase engagement in treatment. Facilitators of and barriers to implementation of integrated behavioral health in a pediatric primary care setting are not well delineated.

We examined the effectiveness of 2 mental health quality improvement strategies: an electronic referral and a social work follow-up protocol. We analyzed the following measures: uptake rate of first mental health appointments, overall use of mental health appointments, and first and overall mental health appointment show rate.

Overall use rate improved after implementation of electronic referral, with 13 consecutive points above the median. First appointment show rates improved with a special cause run occurring after adding social work students to the mental health quality improvement team. First appointment show rate improved from a monthly average of 51% (November 2014 to March 2016) to 78% (April 2016 to December 2016). Use rate improved initially with increased efforts in assisting patients with scheduling; show rate improved more slowly after an emphasis on scheduling patients exhibiting treatment readiness.

Findings suggest that a number of facilitators can increase the effective use of mental health services in an integrated adolescent clinical setting. These include an electronic referral through a shared electronic health record, multidisciplinary collaboration, and care management by social workers equipped with a variety of clinical and care coordination skills.