131 - Therapy: A Transdisciplinary Healthy Equity Relationship: Allegro Pediatrics + Youth Eastside Services (YES) —A Collaborative Mental Health Care Intervention for Adolescents

Publication Number: 1121.131

Megan Wills. Kullnat, Johns Hopkins University School of Medicine, Clyde Hill, WA, United States; Amy E. Carter, Allegro Pediatrics, Bellevue, WA, United States; Maria Trent, Johns Hopkins University, Baltimore, MD, United States

Background: American youth are experiencing rising rates of anxiety, depression and suicidal ideation, leading the American Academy of Pediatrics to declare adolescent mental health a national emergency. There are an insufficient number of pediatric mental health providers to address this growing need.

Objective: The purpose of this study is to examine the impact of collaborative care on depression, anxiety and suicidal behaviors amongst low-income youth. We propose that collaboration between a youth's mental health team and primary care medical home will improve mental health outcomes and offers a solution to America's adolescent mental health care crisis.

Design/Methods: We enrolled 30 Medicaid-insured youth ages 9-18 years into a 6-month pilot with their primary care pediatrician, a master-level pediatric therapist, a social worker, and a child psychiatrist. Enrolled youth received weekly trauma-focused cognitive behavioral therapy, and the care team met weekly to evaluate their progress. We used evidence-based rating scales to measure anxiety (generalized anxiety disorder 7-item, or GAD7) and depression (patient health questionnaire 9-item or PHQ9) at baseline and at program completion. Finally, we collected patient, family and provider experience surveys.

Results: The mean patient age was 14 years (+/- 2 SD), two-thirds are minority youth, and gender was equally distributed. All youth in Therapy are Medicaid-insured, and most have experienced adverse childhood events placing them at increased risk for mental health adversity, including abuse (73%) and housing insecurity (20%). Nearly half of the youth enrolled in this pilot reported suicidal ideation (47%) and/or self-harming behaviors (43%). There were no emergency department visits, mental health hospitalizations or suicide attempts during the pilot. Compared with baseline levels, there was a significant reduction in depression scores from 12.2 (with a 95% CI of 9.4 to 15, SE= 1.4) to 9.2 (95% CI 6.4 to 12.1, SE= 1.4), and p= 0.02. There was a significant reduction in anxiety scores from 9.8 (with a 95% CI of 7.5 to 12.2, SE= 1.1) to 7.8 (95% CI 5.3 to 10.2, SE= 1.2) and p= 0.002. Our provider, patient and family exit feedback was uniformly favorable.

Conclusion(s): The results of this pilot suggest that collaborative mental health care interventions, like our program Therapy, improve youth anxiety, depression and suicidal behaviors. This program has meaningful public health implications if it could be implemented broadly for the highest-risk youth.

Pre- and post-intervention anxiety (GAD7) scores
Generalized anxiety disorder 7-item (GAD7) questionnaire

Pre- and post-intervention depression (PHQ9) scores
Patient health questionnaire 9-item (PHQ9)

Statistical data analysis of mean depression (PHQ9) and anxiety (GAD7) scores