O1005: Improving Mental Health Access and Integration for Children and Adolescents During the covid-19 Pandemic: A State-wide Quality Improvement Collaboration

Purpose/Objectives: The American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association issued a national emergency in children’s mental health due to the COVID-19 pandemic. However, even prior to the pandemic, rates of childhood mental health problems and suicide rates were steadily increasing. As front-line clinicians dedicated to child health, Pediatricians have variable knowledge and experience in identifying and treating childhood mental health problems. Furthermore, the variation in levels of mental health integration across primary care practices results in limited and fragmented response to the mental health needs of children and adolescents.

1. Increase access to mental health care within Pediatric medical homes
2. Improve mental health integration across systems of care between behavioral/mental health organizations and primary care providers

Design/Methods: Led by the Utah Pediatric Partnership to Improve Healthcare Quality, 7 large pediatric ambulatory health systems (involving 24 practices) co-created a two-year quality improvement initiative aimed to improve access and integration of mental health services for children and adolescents. Pediatric practice teams (clinical providers, nursing, administrative staff) collaborated with behavioral/mental health therapy organizations state-wide from January 2020 to December 2021 during the height of the COVID pandemic.
Primary care clinicians received didactic instruction from psychiatrists to support diagnosis & management of common mental health conditions including Traumatic Stress, Depression, Anxiety, Suicide, and Substance Use. Teams participated in monthly meetings to learn QI principles according to the “Model for Improvement.” With external facilitation from a QI specialist, teams designed and implemented process changes with the goal of achieving 80% screening of pre-defined populations for depression, anxiety, and/or childhood trauma.
Concurrently, practice teams tested pairing a template form with a behavioral/mental health registry to support bidirectional communication with behavioral health therapy organizations.
At monthly team meetings, practice-specific and aggregate data reporting provided opportunities for shared learning and discussions including barriers and solutions for progress through cycles of change.

Results: For baseline measurements, teams reviewed a random sample of targeted patient populations identified for screening of depression, anxiety, and/or childhood trauma for a total N=3000. Regular quarterly measurement occurred to track progress of screening (random sample N>1000 each cycle). There was substantial increase in aggregate performance (from a baseline of 51.7% to 93% at the conclusion of 2021) for screening of depression, anxiety, and/or traumatic stress.
Results of balancing measures included 90% of participants indicated process changes did not disrupt patient experience, and 95% of participants agreed collaborative care with a QI specialist improved patient care.

Conclusion/Discussion: Through a 2-year Quality Improvement Learning Collaborative during the height of the CoVID-19 Pandemic, Pediatric practices collaborated statewide to increase mental health access and integration for children and adolescents including improved communication and referral to therapy organizations.