O3193: Primary Care Engagement in Increasing Access to Stepped Triage to Mental Health Care Within the Context of Disasters and All Hazards Events

Background: Youth mental health needs have been rising since 2009, with increasing rates of MH diagnosis, hospitalization, and suicide. Like other disasters, COVID exacerbated that situation, creating strain on an overloaded system. And as in other disasters and crisis events, lack of MH resources disproportionately impacted youth of color, lower SES and marginalized communities. Barriers to care included limited access to evidence-based care, difficulty engaging in-person care, and cost.

Project Description: With funding from the Washington State Dept of Health, and Healthcare Authority, The Stepped Triage to Trauma-Focused Cognitive Behavioral Therapy was developed to promote equitable access to mental health care through a telehealth service delivery. The project further aimed to reduce barriers by providing services at no cost, along with increasing the MH workforce.

The Stepped Triage to Care model used in the WA DOH project evolved from collaboration and engagement with 2 HHS initiatives for children in disaster:
1) ASPR WRAP-EM Pediatric Disaster Center of Excellence 2) Mental Health Domain of the HRSA Pediatric Pandemic Network, whose MH members provided guidance and technical support for this project.

Engaging systems where youth present with MH concerns, specifically primary care, was critical. Pediatricians at a large multi-site primary care pediatric group screened patients for MH concerns, and then referred them internally to behavioral-health care coordinators who triaged for trauma using the PsySTART® triage system. Youth identified as “at risk” were referred to the University of Washington Psychological Services and Training Center, which provided virtual case management and treatment.

The TF-CBT was delivered in two “steps”. All youth and their parents and caregivers received the first four modules of TF-CBT, and then were re-evaluated. Approximately 50% were sufficiently improved to “graduate” from care. The remaining went on to complete the four additional TF-CBT modules.

Discussion: Over 47 weeks of the project 123 children were triaged, of which 48% were referred via primary care. Symptom screening following TF-CBT demonstrated high rates of improvement based on youth/caregiver reports. Using the “stepped” model for TF-CBT increased clinician efficiency by 67%, creating additional access for other youth to receive treatment. Pediatricians reported that the ability to refer patients to timely, quality mental health care improved their patient outcomes and also their ability to care for the acute and preventative medical needs of patients during a time of reduced capacity in the healthcare system.

Conclusion: • Primary care practices can efficiently learn to identify youth who are objectively most in need of trauma-focused mental health services, and using this data, equitably prioritize them to care.
• This project demonstrated the capacity for seamless triage to evidence-based care, starting with the primary care provider, and is a model for managing mental health surge in disasters, and increasing access to care.