344 - Improving Referral Completion to Integrated Behavioral Health at a Community Federally Qualified Health Center

Poster Number: 344
Publication Number: 344.345

Christopher H. Kim, University of California Davis Children's Hospital, Sacramento, CA, United States; Alisha Mathalikunnel, UC Davis, Sacramento, CA, United States; Erik Fernandez Y Garcia, University of California Davis Children's Hospital, sacramento, CA, United States

Background: The Covid-19 pandemic has highlighted longstanding deficiencies in connecting pediatric and adolescent patients to mental health services. The Sacramento Native American Health Center (SNAHC) is a Federally Qualified Health Center providing primary care and co-located integrated behavioral health (IBH) services to a majority non-white, 100% publicly-insured population. Despite the availability of IBH, many referrals for younger patients do not result in appointments. We present initial results from a quality improvement effort to increase timely appointments with IBH following referral.

Objective: We aim to increase IBH referral completion rate (RCR), defined as the percentage of referrals resulting in an IBH appointment within 1 month of referral date, from a baseline of 20% to 40% over a 9-month period.

Design/Methods: Referrals to IBH for patients 19 years old are identified in monthly reports provided by the SNAHC referral coordination team. Referred patient charts are examined at least 1 month following referral date to determine RCR. Barriers to referral completion were also identified via chart documentation.
Following review of baseline data from 7/21–9/21, we developed an intervention with IBH leadership focused on warm handoffs (WHs): IBH conducting in-person visits during the medical visit when the referral is made. A dedicated HIPPA compliant instant messaging chat was established for WH requests. A process measure count of WHs was assessed via chat record and/or IBH documentation.

Results: Baseline RCR was 20% (Fig 1), with two WHs performed during baseline period (Fig 2). The main barriers to referral completion were inability to contact families and incomplete treatment consent (Fig 3). Following intervention start, an increase in WHs (Fig 2) corresponded to increases in RCR above baseline (Oct: 67%, Nov: 25% (preliminary data))(Fig 1). RCR among referrals where WH was performed is 75% through baseline and intervention.Conclusion(s): Our initial results support the use of WHs to increase RCR to IBH among pediatric patients at SNAHC. WHs address the main identified barriers to referral completion, verifying contact information and consent completion. Some WHs immediately determined that referral to pediatric specialists outside of SNAHC was more appropriate, making the process to appropriate care timelier. Prior studies have shown mixed results in the utility of WHs for IBH services. However, these have not occurred in pediatric populations where unique barriers such as parental consent or redirection of referrals for pediatric-specific mental health conditions exist.
Figure 1: Monthly Referral Completion RatePercentage of referrals to integrated behavioral health resulting in an appointment scheduled/completed within 1 month of referral date, by month of referral date. Baseline period shaded in gray. * denotes preliminary data (additional referrals may be identified in future review).
Figure 2: Monthly Warm Handoff Completion CountNumber of warm handoffs to integrated behavioral health providers completed by month. Baseline period shaded in gray. NB: not all warm handoffs resulted in, or were associated with, an integrated behavioral health referral. * denotes preliminary data (additional warm handoffs may be identified in future review).