86 - Addressing adolescent mental health through practice facilitation

Publication Number: 4084.86

Diane Liu, University of Utah School of Medicine, SLC, UT, United States; Gabriele Baraghoshi, University of Utah School of Medicine, Salt Lake City, UT, United States; Athena Parker, University of Utah School of Medicine, Arden, NC, United States; Ryan Rupper, University of Utah School of Medicine, Herriman, UT, United States; Megan Brandt-Cornwell, Intermountain Health, Ogden, UT, United States; Sarah Harward, Primary Children's Hospital, Salt Lake City, UT, United States; Seth Andrews, Primary Children's Hospital, Salt Lake City, UT, United States; Carolyn C. Reynolds, Primary Children's Hospital, Salt Lake City, UT, United States; Neal Davis, Primary Children's Hospital, Murray, UT, United States; Justin Alvey, University of Utah School of Medicine, Salt Lake City, UT, United States; Lisa Giles, University of Utah, Salt Lake City, UT, United States; Angelo P. Giardino, University of Utah, salt lake city, UT, United States

Background: Adolescent mental health remains a critical health issue in the United States. Despite increased attention to this crisis, significant gaps in mental health care persist - driven largely by a fragmented care delivery system and challenges related to payment reform. Practice facilitation, an evidence-based approach for improving primary care delivery and patient outcomes, has demonstrated effectiveness in adult-care settings. Its integration into Pediatric quality improvement activities remains limited, representing a missed opportunity for scalable population-level impact.

Objective: Pediatric clinicians from multiple health systems in Utah mobilized through a coordinated effort utilizing practice facilitation to enhance access and response to adolescent mental health through integrated pediatric care.

Design/Methods: Intermountain Children's Health and the Utah Pediatric Partnership to Improve Healthcare Quality (UPIQ) led 55 primary care practices in a 3-year quality initiative to improve access to, identification of, and response to adolescent (ages 12 to 17) mental health needs. Intervention clinics received QI facilitation with data feedback, and monthly collaborative meetings with community partners including child psychiatrists. We monitored proportion screened for mental health using validated tools at well-child visits in intervention clinics. At the population level, changes in proportion screened were compared with non-intervention clinics using statistical process control (SPC).

Results: Mean proportion of patients screened for mental health during well-child visits at intervention practices increased by 15% and 20% (2023 & 2025 cohort, image 1). SPC results reflect improving center line for intervention clinics compared to non-intervention clinics (image 2). Emergency department visits for mental health by attributed population reduced from 7 to 4 per 10K member months (image 3).

Conclusion(s): This state-wide initiative demonstrates that practice facilitation may serve as a powerful lever to improve care processes and patient outcomes for adolescent mental health. Intervention clinics achieved significant and sustained increases in screening rates and reductions in mental health-related emergency department visits. Our findings demonstrate that practice facilitation strengthened implementation of evidence-based practices and reduced crisis-driven care. As health systems seek scalable value-based population health strategies to address youth mental health, practice facilitation serves as a key component in advancing system-level change.

Image 1. Aggregate Run Charts
Aggregate run charts reflecting proportion (numerator/denominator) of patients screened for mental health using validated tools at well-child visits in intervention clinics (2023 cohort - Pediatric practices; 2025 cohort - Multidisciplinary practices)

Image 2. SPC charts
SPC UCL/LCL/mean of attributed population screened for mental health using a validated tool comparing intervention (UPIQ) clinics to non-intervention (non-UPIQ) clinics by commercial and Medicaid payers. Numerator: The number of adolescents from the denominator who completed a well child visit and a behavioral health assessment during the last 12 months. Denominator: The number of adolescents turning 13-18 old during a given month in the full attributed population

Image 3. Mental health-related ED visits for attributed population
Reduction in mental health-related emergency department visits for intervention clinics' attributed population from 7 to 4 per 10,000 member months (2019-2025)