Presentations

Abstract

Introduction:

In the US, our system includes a critical gap between the need for pediatric mental healthcare and an adequate workforce.1 Fewer than two-thirds of patients referred to mental health will attend an appointment. Only one-third of those patients will receive follow-up care.2

CHKD has implemented a Stepped Care Model (SCM) approach to outpatient care to match a child's level of symptoms to appropriate intervention in a timely manner. A key element of SCM is a brief triage assessment after which most patients with lower acuity are offered low intensity group support instead of a passive waitlist. Patients with higher needs receive priority status for more rapid access to individual care. Compared to traditional care models, SCM approaches show both non-inferior results and cost-effectiveness.3,4

This study explores SCM at CHKD to examine interval duration between care components, the rate at which patients receive recommended treatments, and identify any disparities in accessing care.

Methods:

A chart review of patients who received a Brief Childhood Needs Assessment (BCNA) with CHKD Mental Health, extracting documented treatment plans and dates and types of clinical encounters. 120 randomly selected patients seen for BCNA from four different time periods (July 2021, Jan 2022, July 2022, January 2023) were included.

Results:

Overall, the wait time after BCNA for group therapy was 8.4 weeks (SD 6.0). However, out of the 78 patients with a recommended treatment plan of group, only 26 attended (33.3%). On average, patients waited 15.21 weeks (SD 15.66) to reach any mental health service (including group) following their BCNA, with this number falling to 8.8 weeks (SD 8.7) in the most recent cohort. Our analyses found no statistically significant disparities in waitlist times among various demographics.

Conclusions:

In the current national child mental health crisis, wait times for MH services from BCNA to definitive care exceed optimal durations, although a decrease in nearly 50% wait time in the most recent cohort is promising. Limited engagement in low intensity support will be an important target for improvement, possibly expanding options to include app-based support. Examination of differences in wait times by provider discipline and child and family characteristics will provide additional opportunities for improvement.