Successfully Transforming Behavioral Health Care Delivery to Rural Adolescents Through Integration and Telemedicine

Altarum created the innovative Responding to Adolescent Depression through Integration and Telemedicine (RAD-IT) pilot program to improve the mental health outcomes of adolescents in rural Michigan. While depression is a serious public health issue that affects many adolescents across the U.S., unfortunately, it is often left untreated. The RAD-IT program is aimed to increase recognition of depression among Michigan adolescents in appointments with their primary care physician (PCP) as well as provide timely, effective treatment for those most at risk for mental health issues and those most likely to face significant barriers to accessing treatment services.

With funding from Michigan Health Endowment Fund and with partners in the Upper Midwest Telehealth Resource Center, the Michigan Center for Rural Health, and CISCO, Altarum embarked on a two-year program. This effort involved training 45 primary care and family clinicians across 15 practices to integrate behavioral health (BH) screening, treatment, and follow-up into their telehealth practices. The clinicians were trained to provide universal screening for depression among adolescents and on how to establish telehealth services connecting vulnerable youth to providers who specialize in adolescent mental health. Over the course of the program, Altarum and its partners trained 53 clinicians and practice staff, reaching more than 2,000 adolescents in rural areas of Michigan.

The program’s impact was significant. The screening rates for adolescent depression increased from 28 percent at baseline to 72 percent post-training, and follow-up for adolescents with moderate to severe depression risk increased from 24 percent at baseline to 37 percent post-training. Most importantly, 64 percent of adolescents with mild to moderate depression risk who received follow-up appointments saw an improvement in their PHQ-A scores — a measure that assesses the severity of clinically significant symptoms of depressive disorders and episodes.

Clinician confidence in meeting the needs of adolescents experiencing depression increased from 54 percent at baseline to 96 percent post-training. In addition, clinician knowledge and comfort around prescribing antidepressants for adolescents in need increased from 67 percent at baseline to 88 percent post-training.

The RAD-IT program’s results show that PCPs can seamlessly integrate adolescent BH care into their practices, increase patient access to BH services, and improve patient outcomes. Clinicians found the BH specialist network to be one of the most useful elements of the program, demonstrating that a tele-behavioral health network is an important intervention for expanding access to care. All things considered, RAD-IT revealed that improving training and access to BH resources for PCPs is critical, especially considering the national behavioral health workforce shortage and the impact of COVID-19.

One clinician who participated in the program noted its effectiveness in demonstrating the role practitioners can play in addressing adolescent depression. “I began paying more attention to the mental health needs of my patients. Providing mental health services has never been my strength. I’d rather treat an infection any day. The RAD-IT program helped me realize the role I can play in identifying and treating depression in adolescents.”

The RAD-IT program’s success could be a model for other states and regions facing similar challenges. With the growing national mental health crisis, programs like RAD-IT are critical for expanding and improving adolescent behavioral health in rural areas and beyond.