Abstract
Community-based agencies are challenged with providing mental health care services with limited resources. When services are not provided, children are at increased risk for ongoing symptoms. The purpose of this study was to determine the effectiveness of the hub and spoke model of telemental services on the quality of function, access to care, and medication management. A retrospective case controlled design was used to examine study objectives. Five hundred and fifty-seven charts were reviewed for persons aged 6 to 17 from January 1, 2010 to December 31, 2015 and after propensity score matching was applied, 86 remained for analysis. Seventy-nine persons out of 301 (26%) in the comparison group; 43 persons out of 256 (17%) in the treatment group were selected due to having complete records. Results of the T-test suggested that telemental services were not inferior to face to face services. Access to care, analyzed via the Chi-Squared test, increased significantly across geographic regions and among person with different living arrangements. A T-test was conducted to compare medication non-adherence between groups; no statistical significance was noted. Telemental services are a viable option to increase access to community-based care and increase quality of function.
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Aday, L. A., & Andersen, R. (1974). A framework for the study of access to medical care. Health Services Research, 9(3), 208–220.
Akingbola, K., Rogers, S. E., & Baluch, A. (2019). Nature of change in nonprofit organizations. Change Management in Nonprofit Organizations (pp. 37–72). Cham: Palgrave Macmillan.
Austin, P. C. (2010). Statistical criteria for selecting the optimal number of untreated subjects matched to each treated subject when using many-to-one matching on the propensity score. American Journal of Epidemiology, 172(9), 1092–1097.
Badawy, S. M., & Kuhns, L. M. (2017). Texting and mobile phone app interventions for improving adherence to preventive behavior in adolescents: a systematic review. JMIR mHealth and uHealth, 5(4), e50.
Baker Act Involuntary Examination: Criteria, Processes and Timeframes. (2002). Retrieved from https://www.dcf.state.fl.us/programs/samh/MentalHealth/laws/bainvex.pdf
Beal, S. J., & Greiner, M. V. (2015). Children in nonparental care: Health and social risks. Pediatric Research, 79(1–2), 184–190.
Beck, R. G. (1973). Economic class and access to physician services under public medical care insurance. International Journal of Health Services, 3(3), 341–355.
Bice-Urbach, B. J., & Kratochwill, T. R. (2016). Teleconsultation: The use of technology to improve evidence-based practices in rural communities. Journal of school Psychology, 56, 27–43.
Ciechanowski, P. S., Katon, W. J., & Russo, J. E. (2000). Depression and diabetes: Impact of depressive symptoms on adherence, function, and costs. Archives of internal medicine, 160(21), 3278–3285.
Clarke, A., Kuosmanen, T., & Barry, M. (2015). A Systematic review of online youth mental health promotion and prevention interventions. Journal of Youth & Adolescence, 44(1), 90–113. https://doi.org/10.1007/s10964-014-0165-0.
Cullins, L. M., Gabriel, M., Solages, M., Call, D., McKnight, S., Concepcion, M., et al. (2016). Pediatric community mental health. Current Problems in Pediatric and Adolescent Health Care, 46(11), 354–388.
Elrod, J. K., & John, L. F., Jr. (2017). The hub-and-spoke organization design: An avenue for serving patients well. BMC Health Services Research, 17(July), 25–33. https://doi.org/10.1186/s12913-017-2341-x.
Forchuk, C., Reiss, J., Eichstedt, J., Singh, D., Collins, K., Rudnick, A., … Fisman, S. (2016). The youth-mental health engagement network: An exploratory pilot study of a smartphone and computer-based personal health record for youth experiencing depressive symptoms. International Journal of Mental Health, 45(3), 205–222
Fox, P. (1972). Access to medical care for the poor: The federal perspective. Medical Care, 10(3), 272–277.
Gajria, K., Lu, M., Sikirica, V., Greven, P., Zhong, Y., Qin, P., et al. (2014). Adherence, persistence, and medication discontinuation in patients with attention-deficit/hyperactivity disorder–a systematic literature review. Neuropsychiatric Disease and Treatment, 10, 1543–1569.
Gloff, N. E., LeNoue, S. R., Novins, D. K., & Myers, K. (2015). Telemental health for children and adolescents. International Review of Psychiatry, 27(6), 513–524.
Green, B., Shirk, S., Hanze, D., & Wanstrath, J. (1994). The Children’s global assessment scale in clinical practice: An empirical evaluation. Journal of the American Academy of Child & Adolescent Psychiatry, 33(8), 1158–1164.
Guerrero, A. P. S., Balon, R., Beresin, E. V., et al. (2019). Rural mental health training: An emerging imperative to address health disparities. Academic Psychiatry, 43, 1–5. https://doi.org/10.1007/s40596-018-1012-5.
Hilty, D. M., Ferrer, D. C., Parish, M. B., Johnston, B., Callahan, E. J., & Yellowlees, P. M. (2013). The effectiveness of telemental health: A 2013 review. Telemedicine Journal and E-Health: The Official Journal of The American Telemedicine Association, 19(6), 444–454.
Holland, J., Hatcher, W., & Meares, W. (2018). Understanding the implementation of telemental health in rural Mississippi: An exploratory study of using technology to improve health outcomes in impoverished communities. Journal of Health & Human Services Administration, 41(1), 52–86.
Hom, C. L., Touchette, P., Nguyen, V., Fernandez, G., Tournay, A., Plon, L., & ... Lott, I. T. (2015). The relationship between living arrangement and adherence to antiepileptic medications among individuals with developmental disabilities. Journal of Intellectual Disability Research, 59(1), 48–54
National Research Council. (2001). Improving access to oral health care for vulnerable and underserved populations. Washington, DC: The National Academies Press.
Kandola, D., Banner, D., Araki, Y., Bates, J., Hadi, H., & Lear, S. (2018). The participant recruitment outcomes (PRO) study: Exploring contemporary perspectives of telehealth trial non-participation through insights from patients clinicians study investigators and study staff. Contemporary Clinical Trials Communications, 11, 75–82. https://doi.org/10.1016/j.conctc.2018.05.005.
Kelleher, I., Wigman, J. T. W., Harley, M., O’Hanlon, E., Coughlan, H., Rawdon, C., … Cannon, M. (2015). Psychotic experiences in the population: Association with functioning and mental distress. Schizophrenia Research, 165, 9–14
Khesht-Masjedi, M., Shokrgozar, S., Abdollahi, E., Habibi, B., Asghari, T., Ofoghi, R., et al. (2019). The relationship between gender, age, anxiety, depression, and academic achievement among teenagers. Journal of Family Medicine & Primary Care, 8(3), 799–804.
Kjos, A. L., & Bryant, G. A. (2019). Communication networks of medication management in an ambulatory care setting. Research in Social and Administrative Pharmacy, 15(2), 182–192.
Lundh, A., Forsman, M., Serlachius, E., Långström, N., Lichtenstein, P., & Landén, M. (2016). Psychosocial functioning in adolescent patients assessed with Children's Global Assessment Scale (CGAS) predicts negative outcomes from age 18: A cohort study. Psychiatry Research, 242, 295–301.
McCarty, C. C., Vander Stoep, A., Violette, H., & Myers, K. (2015). Interventions developed for psychiatric and behavioral treatment in the children's ADHD telemental health treatment study. Journal of Child & Family Studies, 24(6), 1735–1743.
Mora Ringle, V. A., Scott Hickey, J., & Jensen-Doss, A. (2019). Patterns and predictors of compliance with utilization management guidelines supporting a state policy to improve the quality of youth mental health services. Children and Youth Services Review, 96, 194–203.
Myers, K., & Comer, J. S. (2016). The case for telemental health for improving the accessibility and quality of children's mental health services. Journal of Child and Adolescent Psychopharmacology, 26(3), 186–191.
Myers, K., Vander Stoep, A., Zhou, C., McCarty, C. A., & Katon, W. (2015). New research: Effectiveness of a telehealth service delivery model for treating attention-deficit/hyperactivity disorder: A community-based randomized controlled trial. Journal of The American Academy of Child & Adolescent Psychiatry, 54, 263–274.
Nelson, E., Cain, S., & Sharp, S. (2017). Considerations for conducting telemental health with children and adolescences. Children Adolescence Psychiatric Clinical North America, 26, 77–91.
Platt, R., Pustilnik, S., Connors, E., Gloff, N., & Bower, K. (2018). Severity of mental health concerns in pediatric primary care and the role of child psychiatry access programs. General Hospital Psychiatry, 53, 12–18. https://doi.org/10.1016/j.genhosppsych.2018.02.010.
Rimsza, M. E., Hotaling, A. J., Keown, M. E., Marcin, J. P., Moskowitz, W. B., Sigrest, T. D., et al. (2015). The use of telemedicine to address access and physician workforce shortages. Pediatrics, 136(1), 202–209.
Rockhill, C., Violette, H., Vander Stoep, A., Grover, S., & Myers, K. (2013). Caregivers’ distress: Youth with attention deficit/hyperactivity disorder and comorbid disorders assessed via telemental health. Journal of Child and Adolescent Psychopharmacology, 23, 379–385.
Roehl, A., & Stewart, A. H. (2018). Impact of social networking sites and digital applications upon teens. Journal of Family & Consumer Sciences, 110(2), 37–42.
Shaffer, D., Gould, M. S., Brasic, J., Ambrosini, P., Fisher, P., Bird, H., et al. (1983). A children's global assessment scale (CGAS). Archives of General Psychiatry, 40(11), 1228–1231.
Tse, Y. J., McCarty, C. A., Stoep, A. V., & Myers, K. M. (2015). Teletherapy delivery of caregiver behavior training for children with attention-deficit hyperactivity disorder. Telemedicine & E-Health, 21(6), 451–458.
Turney, K., & Wildeman, C. (2016). Mental and physical health of children in foster care. Pediatrics, 138(5), E20161118.
Topaloglu, O., McDonald, R. E., & Hunt, S. D. (2018). The theoretical foundations of nonprofit competition: A resource-advantage theory approach. Journal of Nonprofit & Public Sector Marketing, 30(3), 229–250.
Watson, T., Simpson, S., & Hughes, C. (2016). Text messaging interventions for individuals with mental health disorders including substance use: A systematic review. Psychiatry Research, 243, 255–262.
Williams, D. R., Priest, N., & Anderson, N. B. (2016). Understanding associations among race, socioeconomic status, and health: Patterns and prospects. Health Psychology, 35(4), 407.
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Williams, C. Using the Hub and Spoke Model of Telemental Health to Expand the Reach of Community Based Care in the United States. Community Ment Health J 57, 49–56 (2021). https://doi.org/10.1007/s10597-020-00675-8
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DOI: https://doi.org/10.1007/s10597-020-00675-8