Correlation of Warm Handoffs Versus Electronic Referrals and Engagement With Mental Health Services Co-located in a Pediatric Primary Care Clinic

Objective: To analyze the correlation of referral mechanism-warm handoff or electronic referral and attendance at behavioral health appointments in an outpatient pediatric primary care setting. Methods: A retrospective cohort study was conducted in an inner-city pediatric primary care clinic from January 2019 to December 2019. Adolescent patients who screened positive for depression or anxiety were referred to a Licensed Master Social Worker (LMSW) either via a warm handoff (WH group, n = 148) or an electronic referral (EF group, n = 180). The EF group was contacted by the LMSW via telephone to schedule an appointment. Multiple logistic regression was used to analyze the correlation of type of referral, age, gender, race/ethnicity, primary language, and time between referral and first contact with attendance at three appointments. Results: The WH group was more likely to engage with mental health services compared to the EF group (odds ratio = 3.301, 95% confidence interval = 1.850-5.902, p = .002) while age, gender, race/ethnicity, and primary language had no correlation. Within the EF group, those who were contacted by the LMSW within 3 days (1-3 days group) were more likely to attend appointments (odds ratio = 2.680, 95% confidence interval = 0.414-8.219, p = .040). There was no difference in attendance in the WH group and the 1-3 days group (p = .913) Discussion: A warm handoff between primary care providers and behavioral health clinicians is significantly correlated with engagement with behavioral health services for adolescents who screen positive for depression or anxiety. Contact with the family within 3 days of referral is significantly correlated with engagement compared to a longer duration between referral and family contact.