• By Laura Whybra
  • Posted on Monday 18th November, 2013

It’s good to talk: how a short phone call improved attendance at CAMHS clinics

strong>When children and young people miss appointments at mental health clinics the consequences include wasted resources and longer waiting lists for others, as well as the risk that their problems will go untreated. But a short phone call to parents before a first appointment can make a big difference to attendance rates, according to London-based researchers.Missed appointments at child and adolescent health services (CAMHS) are a major problem on both side of the Atlantic. In the UK, it has been estimated that between 15-35 per cent of children and young people referred to clinics fail to attend their first appointment, with non-attendance rates as high as 58 per cent reported in the US.Researchers at the Institute of Psychiatry, working with families living in a socially disadvantaged and ethnically diverse area of South London, decided that sending out reminder letters to parents was not enough and that clinicians should telephone them before their child’s first appointment. A pro-forma for structuring the content of each call was based on existing evidence and discussions with local families and practitioners about concerns that can prevent parents bringing their children to clinics as well as structural barriers that limit attendance, like transport and arranging childcare for siblings.Under six main headings, clinicians reminded parents about the appointment time and location before talking about their child’s mental health problems and their views about the referral to CAMHS. The other topics covered were what to expect at the first appointment and practical arrangements for keeping the appointment.Getting through to parentsA quasi-experimental evaluation study examined the attendance records for 107 cases over a six-month period where parents received the telephone call (or, in two cases, were seen face-to-face). These were compared with a control groups of 62 cases of families where attempted phone contact was unsuccessful and 163 cases referred during the previous six months who had been sent standard letters about their appointment and arrangements for opting out.Analysis showed that families who received the intervention were significantly less likely to miss their initial appointments, compared to those in the two control groups. Just 10 per cent who were telephoned missed their first appointment, satisfying the highest quality benchmark of a “Did Not Attend” (DNA) rate below 13 per cent specified by the UK’s National Health Service. This compared with non-attendance rates of 21 per cent for referrals in the previous six months and 55 per cent among families where the attempted phone contact failed.Attendance rates were also found to be better for the first three appointments where parents had received the initial telephone call. Although 22 per cent of children and young people in the telephone group missed at least one appointment, this rose to 35 per cent among those referred in the sex months before the intervention and 60 per cent where telephone contact had not been achieved. Reaching ethnic minoritiesThe study also found that the telephone intervention had similar effects for white and minority ethnic families taking part, and for those living in the most and least deprived parts of the clinic’s catchment area. This is encouraging given previous research suggesting that fear of social stigma through involvement with CAMHS services and concerns about culturally appropriate care may be particular barriers to accessing treatment among African-American parents in the US and South Asian families in the UK. The researchers acknowledge limitations to their study. For example, that the control group parents who did not reply to phone messages or could not be reached by telephone for other reasons might have been less likely to attend a CAMHS appointment even if they had received the intervention. A check on the fidelity with which clinicians followed the pro-forma for calls also suggested they prioritized discussion of carers’ expectations and attitudes over logistical barriers to keeping the appointment.Nevertheless, it seems that a relatively brief, structured phone call can help to prevent waste and ensure that more children and young people who need mental health treatment receive it. In addition, a pre-appointment call proved more effective than a letter in screening out families who no longer wanted their child referred to CAMHS,Future research could sensibly consider more precisely how early contact may influence individuals’ subsequent decision to attend appointments. AS the authors suggest, it could also probe more deeply into the training and supervision required to support clinicians when making pre-appointment calls.**************ReferenceMichelson, D. & Day, C. (2013). Improving Attendance at Child and Adolescent Mental Health Services for Families from Socially Disadvantaged Communities: Evaluation of a Pre-Intake Engagement Intervention in the UK. Administration and Policy in Mental Health and Mental Health Services Research. DOI: 10.1007/s10488-012-0462-4

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