Subject:
Primary Care

Short Description:

How Many Teens Actually Go When Referred for Mental Health Services?

Background:

The American Academy of Pediatrics recommends mental health screening as a standard part of well-child physicals. A recent study of adolescents looked at how often they are referred for mental health services by their primary care providers, and when referred, at how often teens followed through with these referrals.

The retrospective chart review of 227, 14- to 17-year-olds with commercial insurance compared teens who screened “positive” (n=117) for mental health referral according to the Pediatric Symptom Checklist or Youth-Pediatric Symptom Checklist to those who were propensity-score-matched negative screens (n=110). Children who were currently receiving mental health care were not included in the study group.

Of the positive youth, 54% were referred for mental health services. Almost half of these (46%) received some type of contact with mental health services—for example a phone call or scheduling an appointment. However, only 18% actually completed a face-to-face mental health visit within the following six months.

PCPs used ICD-9 codes or other notes to provide mental health diagnoses to 39% of the positive screens in the initial screening visit. Of these youths, 57% were referred for mental health services, compared to only 19% of those who screened positive but were not given a psychiatric diagnosis by the PCP.

In addition, children who stated that they had a mental health problem for which they needed help were more likely to be referred (48% of the positive screens) (Hacker K et al, J Adolesc Health 2014;Feb 12, online ahead of print).

CCPR’s Take: This study shows that something is missing in terms of teens with mental health issues going from primary to specialty care. It should be noted that 57% of the teens who were diagnosed with a psychiatric disorder—ranging from depression to disruptive disorders—by their primary care doctors were referred for specialty mental health care. That means 43% were not. It’s not clear where these kids went from there.