Date of Award

Summer 2021

Degree Type

Dissertation

Degree Name

Doctor of Social Work (DSW)

First Advisor

Ram A. Cnaan, MSW, PhD

Second Advisor

Femida Handy, PhD

Abstract

It is estimated that 14 million, or 21% of children residing in the United States meet diagnostic criteria for a mental health and/or substance use disorder (American Academy of Pediatrics, 2016)"}" id="2086950881">(American Academy of Pediatrics, 2016). Additionally, 16% of children and adolescents have impaired mental health functioning that does not meet criteria for a mental health disorder. Unfortunately, approximately 75% to 85% of children with behavioral health concerns do not receive mental health specialty services, and many of them do not receive any treatment at all. Limited resources and long wait times for services are among the many barriers to Behavioral Health care for this population. In addition to quality of life issues, untreated child mental health disorders have profound societal economic consequences. This study set out to evaluate a pilot project that integrates Behavioral Health (BH) care into pediatric departments at a large multi-site, multispecialty primary care organization as a strategy for reducing wait times for child BH services and improving patient outcomes. Data started to be collected and some preliminary findings were obtained but the program did not reach its planned endpoint.

In March of 2020 operations at the primary care organization were severely disrupted by an organizational and financial crisis caused by the necessary safety precautions designed to reduce the spread of infection during the onset of the Covid-19 pandemic. Behavioral Health care at the organization subsequently shifted to a telehealth platform. The in-person pilot program was terminated and reorganized into two new telehealth programs with the same goal of increasing access to BH care by reducing wait times for services. The first of these programs called the Pediatric Behavioral Health Covid Response (PBHCR) team was designed to address the emerging urgent child mental health needs caused by the pandemic. The second program called The Virtual Integration Program was designed to provide general BH care to children. Data for the new pilot program is incomplete, but preliminary results indicate that wait times and no show rates were reduced, and pediatric providers and their patients generally found the program helpful. The Virtual Integration Program was not evaluated. An exploration of operational data for the PBHCR program found that the use of a single session and psychoeducation in the form of Tip Sheets may be an effective strategy for increasing access to child behavioral health care.

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