Role of behavioral outreach worker in increasing mental health service utilization for children.

© 2009 Japan Pediatric Society One of the most important issues in the fi eld of child mental health is the low utilization of mental health services among those who have mental illness. Reasons for lower utilization of mental health services among children may be due to the lack of insurance, prohibitive costs, stigma of visiting mental health services 1 or lengthy waiting time at mental health services. 2,3 In Western countries the outreach worker, who is similar to the social worker but who does not have qualifi cations, 4,5 supports the access of health services for those who require assistance due to language barriers or lack of knowledge. The City of Revere, Massachusetts, USA, has taken a unique approach, involving the introduction of a behavioral outreach worker (BOW), who promotes utilization of mental health services. The city of Revere has one of the highest rates in USA for violence, substance use, depressive symptoms and suicidal attempt. 6 For example, 83% of Revere high school students and 51% of middle school students reported using alcohol in their lifetime. 7 In addition, the percentage of immigrants is very high (5.7% of residents in Revere are Asian, 8 which is higher in comparison with the overall Asian – American rate of 3.6% in the USA 9 ). The main function of the BOW is to provide a link between pediatricians and mental health services for those with identifi ed mental health problems who are either not receiving care or who are receiving inconsistent care ( Fig. 1 ). Massachusetts General Hospital (MGH) Revere HealthCare Center collaborates with Revere Community Awareness, Resources and Education to Prevent Substance Abuse (CARES), North Suffolk Mental Health Association, Revere Police, Revere Public Schools, and especially the Youth Zone program (an after-school program that provides a safe place for youth to develop positive life skills, within the context of a caring environment that will better prepare them to deal with the challenges of adolescence), to address mental health problems among youth. Patients can approach Youth Zone or MGH Revere HealthCare Center, and if pediatricians fi nd patients need more or different mental health services, pediatricians refer to the BOW, and the BOW contacts patients and refers them to the appropriate mental services, including emergency services, outpatients psychiatry, mental health and substance abuse counseling, confi dential services for sexual abuse concern, and domestic violence advocacy/counseling. A BOW is trained to deal with children with mental illnesses. Because the BOW functions as a liaison, qualifi cations in the medical or the welfare fi eld, including nursing, clinical psychology, or social work, are not needed. Thus, this approach is less expensive than hiring medical professionals. The BOW should, however, be familiar with the characteristics of the community, including health services, institutions for youth, and culture of youth in the community. A similar approach was implemented in the UK and it was found that an advice worker was effective in addressing the social and economic needs of patients. 11