Telehealth helps reduce depression in youth, Texas consortium finds
More than 60% of children with major depression in the U.S. do not receive any treatment. In spring 2021, emergency department visits for suspected suicide attempts were nearly 51% higher for adolescent girls compared with the same time period in 2019.
At the same time, there is a critical shortage of behavioral health specialists. By 2024, analysts expect the United States to be at a deficit of as many as 31,000 psychiatrists. 570 counties in the U.S. right now have no mental healthcare providers at all.
In 2019, the Texas Child Mental Health Care Consortium (TCMHCC) received funding for five different statewide behavioral health programs. They include a primary care access program that facilitates consults for primary care physicians; a school-based telehealth access program for direct intervention for students; more.
“Government agencies are trying to solve the mental health crisis by expanding access to behavioral health services,” said Dr. Laurel L. Williams, professor of child adolescent psychiatry at Baylor College of Medicine, medical director, Council on School Health (COSH) for the TCMHCC. “The most-organized efforts now are the primary care access programs collaborative care models.
“Aimed at treating more patients within the primary care setting, they create a formal process through which primary care physicians can reach out to psychiatrists therapists for mental health assistance with their patients,” she continued.
This alignment happened due to Texas legislation that required providers agencies throughout the state to work together. Thus, Texas avoided the fragmented approach that many other states have experienced, she added.
“The two programs I work closely with connect primary care physicians, school counselors school nurses to behavioral health services: the Child Psychiatry Access Network (CPAN) offers peer-to-peer consultation to primary care providers during their work day, the Texas Child Health Access Through Telemedicine (TCHATT) serves at-risk children adolescents with in-school behavioral telehealth care after consent from a legal guardian,” Williams explained.
“To successfully implement these statewide access programs, we needed a HIPAA-compliant, secure platform to achieve our state-mandated goals connect with primary care providers, school personnel parents all within one system that could then provide access to that data for performance review, outcomes development of future programming education,” she said.
Because TCMHCC is state-funded, it had an open procurement process that included a request for proposals from any vendor. Trayt was selected given its ability to customize the build its experience in working directly with youth families to engage, assess synthesize behavioral, medical, life stressors resiliency factors to help clinicians strive toward a whole-person perspective, Williams said.
“Texas is a big state, the consortium is state-funded works with 12 health-related institutions of higher education for CPAN TCHATT,” she explained. “Rather than 24 different solutions for these 24 teams, we needed one platform we could customize per our specifications.”
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MEETING THE CHALLENGE
Trayt’s platform met the technology challenges TCMHCC faced to build a statewide behavioral health program, Williams said. It’s designed specifically for a behavioral health workflow, not adopted from another specialty.
“By design, this solution also focused on expanding the quality of our program to include patient health outcomes, instead of metrics that focused only on the number of engagements, referrals consultations,” she explained.
“The company’s measurement-based care model combines the validated evidence-based measures with symptom-level data from other observers patients’ real-life experiences that patients track in between visits,” she continued. “The platform provides the much-needed valuable data clinicians need in addition to their observation data at the time of visit.”
The platform is intelligent enough to collect analyze more than 750 health environmental factors to help clinicians make better-informed diagnosis treatment decisions, she added. It provides a 360-degree view of the patient, she said.
“With this platform, we can track the patient across the system of care to connect the school counselor the primary care physicians to the psychiatrist,” Williams noted. “This patient-centered component truly brings our vision to reality.”
Early results from Texas are demonstrating statistically significant improvement in patient outcomes:
- In early evaluation, more than 50% of a sample of youth treated for depression have seen significant clinical improvement in their symptoms. More specifically, 50% of students who had moderate to severe scores on the PHQ-9 A at baseline demonstrated a significant reduction in depression scores in follow-up measurement.
- Following treatment, nearly 88% of families reported improvement in their children. In measurement, they rated their children as “doing a lot better” or “doing a little better.”
“By August 2023, we are hoping to reach the greater than 2,000 school districts serving around 5 million students in Texas,” Williams noted. “As of March 2023, we serve 528 school districts on 4,410 school campuses with more than 2.5 million students.
“We know 12,000 students, with their parents’ permission, have downloaded the app used it to check in with their clinical team,” she continued. “We have more than 7,000 school counselors who are part of this care continuum.”
ADVICE FOR OTHERS
Williams has two recommendations for provider organizations using similar technology: Know your needs require flexibility in the technology platform.
“With a statewide access program for behavioral health services, it’s important to know the needs of the program, your staff all users of the technology,” she advised. “I also recommend looking at how what you use technology for now the vision your team has for the program.
“Include the stakeholders in the process to ensure the solution is multifaceted,” she continued. “As a physician, measurement-based care is important in my collaboration with patients their families. I want secure easy access to patient data for the patient to have access as well to ensure the most effective use of our shared time together.”
And, flexibility with a technology platform means the program is easy to change in development of the software later, once implemented, she continued.
“We needed to connect stakeholders across the state design workflows for their unique individual care protocols,” she concluded. “We knew an off-the-shelf solution would not meet the challenges we faced in implementing these connections workflows across the state.”
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