The effectiveness of a digital referral to improve access to Children and Mental Health Services. A prospective observational study with real-world data

Abstract Background In the UK, children and young people's (CYP) mental health needs are increasing, whilst access to care is worsening. This trend is sharper in the North of England and post-COVID-19. Decentralised paper-based referrals may be the root of increased waiting times for the first appointment with Children and Mental Health Services (CAMHS). Health Information Technologies (HIT) has been shown to successfully simplify access to CAMHS, reduce waiting times, provide anonymous support, and reliable information. Yet, there are concerns that self-referrals put extra pressure on CAHMS, leading to adverse outcomes. Methods A single-centre prospective observational study with a historical control group (real-world data RWD) was conducted to evidence the effectiveness of "CYP as One" – a digital single point of referral to CAMHS. The study aims to determine the effectiveness of "CYP as One" in reducing waiting times between referral and the first appointment and reducing rejection rates. Intervention 12-month RWD was compared with Control 12-month RWD. Shapiro Wilk and Kolmogorov Smirnov tests determined that data was not normality distributed. Descriptive statistics and non-parametric tests were conducted. Results Intervention showed an increase in 1,314 referrals, particularly self-referrals (71%). There was an increase in 16.13 days of waiting time in the Intervention (53.89) compared with Control (37.76) (p< .001). The Intervention led to a reduction in waiting time for months 10 (M=16.18, p=9.04E-05), 11 (M=17.45, p=1.38E-08), and 12 (M=31.45, p=1.51E-11). Changes in the number of Accepted, Rejected and Redirected decisions by month and Overall for Control and Intervention. Rejection rates increased due to the increased (108%) volume of referrals. Conclusions The "CYP as One" might contribute to improving access and reducing waiting times for CYP, albeit further research is needed to corroborate these findings. HIT allows the adequate uptake of CYP into CAMHS via self; parent, and professional referrals. However, the available real-world data did not enable investigations on whether referrals with specific mental health-related conditions affect waiting times and staff time. Regardless of the limitations identified, the Intervention promises to be a comprehensive tool for CAMHS collaboration and, consequently, a unifying domain of access to care for CYP.