A trial of telephone services to increase adolescent utilization of health care for psychosocial problems.
OBJECTIVE
Adolescents identified in primary care clinics as experiencing psychosocial problems frequently do not receive recommended referral mental health care services. The purpose of the present study was to test whether a Telephone Support Services (TSS) intervention would increase subsequent healthcare utilization. Our TSS intervention featured a combination of case management and motivational interviewing.


METHODS
One hundred seventy-nine adolescents who screened positive for at least one of three psychosocial problems--depressive symptoms, suicidal ideation, or substance use--were randomly assigned to one of two study conditions. Eighty-nine participants were randomly assigned to TSS, and 90 participants were assigned to Enhanced Usual Care (UC+). Adolescents completed self-report interviews of medical and mental health utilization at 4 months. In addition, research staff queried our hospital's administrative data warehouse to obtain each participant's medical service and mental health service use at 6 months.


RESULTS
TSS did not increase subsequent utilization of either medical or mental health services for adolescents screening positive for psychosocial problems in a primary care clinic. This finding held true whether service utilization was assessed through self-report or administrative data.


CONCLUSIONS
The lack of experimental effect on healthcare utilization suggests that certain aspects of our TSS require modification in future work. On a positive note, given that each of the three TSS calls was completed by a strong majority of participants, TSS appears feasible and acceptable to adolescents with psychosocial problems.
Stevens
Jack
J
Ohio State University Department of Pediatrics and the Research Institute at Nationwide Children's Hospital, Columbus, Ohio 43205, USA. Jack.Stevens@nationwidechildrens.org
Klima
Jennifer
J
Chisolm
Deena
D
Kelleher
Kelly J
KJ
D000293:Adolescent; D016497:Adolescent Health Services / Q000706:statistics & numerical data*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D015397:Program Evaluation; D011584:Psychology; D000297:Psychology, Adolescent; D011795:Surveys and Questionnaires; D013685:Telecommunications; D055815:Young Adult