Both electronic referral and care management by social workers increase the effective use of mental health services for adolescents in the United States significantly, according to research published in Pediatrics.

Mental health problems in adolescents is a large public health issue and uptake of mental health treatment remains low. Researchers at the University of Pittsburgh Medical Center sought to analyze quality improvement strategies designed to integrate behavioral health into primary care.

The research examined 2 strategies: electronic referral and social work follow-up protocol. The authors measured the uptake rate of first mental health appointment, overall mental health appointment use, and first and overall appointment show rate. The data showed that after the implementation of electronic referral, the overall use rate improved greatly. After the addition of social work students to the mental health quality improvement team, first appointment show rates improved from a monthly average of 51% to 78%. The use rate and show rate also improved gradually. After examining 14 consecutive points from November 2015 to December 2016, there was an overall improvement in show rates of first and returning appointments from an average of 67% to 77%.

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There were several limitations involved with this study. The project was a single case study, limiting the generalizability of the outcomes. In addition, some referrals may have occurred but not been entered electronically, and the outcomes measured from the electronic referrals may not fully represent the effectiveness of connecting patients with other mental health services.

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These findings suggest that electronic referrals and social workers equipped with clinical care and coordination skills can increase the effective use of mental health services in an integrated adolescent clinical setting. Underscoring the critical role of social workers, researchers note that, “The skills of social workers allowed them to provide a range of support, including care management, assessing psychosocial barriers to treatment, connecting patients to community resources, and providing brief intervention counseling when needed.” Finally, researchers advocate integrating mental health services into primary care settings for adolescents, young adults, and potentially other primary care settings.


Peters KM, Sadler G, Miller E, Radovic A. An electronic referral and social work protocol to improve access to mental health services. Pediatrics. 2018;142(5).

This article originally appeared on Psychiatry Advisor