Examining the Utility of a Telehealth Warm Handoff in Integrated Primary Care for Improving Patient Engagement in Mental Health Treatment: Randomized Video Vignette Study (Preprint)

Abstract

BACKGROUND A “warm handoff” from a physician to mental health provider is often patients’ first contact with psychological services and affords a unique opportunity for improving treatment engagement in integrated primary care (IPC) settings. OBJECTIVE In light of the COVID-19 pandemic, this study sought to examine the impact of different types of virtual mental health referrals on likelihood of accepting treatment services. METHODS A diverse sample of young adults reporting moderate levels of depression, anxiety, and unmet mental health care needs (N=560) were randomized to one of three video vignettes: a) warm handoff in IPC, b) RAU in IPC, or c) RAU in standard primary care. RESULTS Logistic associations between referral type and likelihood of referral acceptance (χ21 = 10.9, P < .01) and likelihood of continued engagement (χ21 = 32.6, P < .001) were significant. Participants who received a warm handoff were significantly more likely to both accept the referral (b = 0.35; P < .01; OR 1.42, 95% CI 1.15-1.77) and engage in continued treatment (b = 0.62; P < .001; OR 1.87, 95% CI 1.49-2.34) compared to those in the RAU in standard primary care condition. Further, 80% of the sample indicated that they would be at least somewhat likely to access IPC mental health services if they were readily available in their own primary care physician’s office. CONCLUSIONS The virtual warm handoff resulted in the increased likelihood of both initial and continued engagement in mental health treatment. Implementing a warm handoff whenever possible is encouraged. Further research regarding virtual mental health referrals is needed to elucidate the impact of the virtual context on referral acceptance and continued treatment engagement and to optimize the warm handoff for virtual settings.