Helping more young patients stay connected to psychiatric care - Children's National

For children and teens receiving psychiatric care, regular follow-up visits can be an important part of staying on track. But when an appointment is missed, care may be disrupted and a valuable opening can go unused. A new Children's Nationalstudy, published in the Journal of Ambulatory Care Management, looked at practical ways clinics can help more families make it to those visits.

The big picture

Researchers examined 53,507 child and adolescent psychiatry clinic follow-up appointments. Over the course of the study, the missed appointment rate (MAR) dropped from 12% to 6%. Families were also more likely to attend virtual appointments - 5.6% of those visits were missed, compared with 11.1% of in-person appointments.

The improvement did not come from a single change. The clinic offered virtual visits, reached out to families about attendance and made communication more consistent. Together, those steps helped more patients return for care and allowed the clinic to make better use of its available appointments.

The hold-up in the field

Earlier studies have often looked at reminders, scheduling changes or virtual care on their own. They have also sometimes grouped new-patient appointments with follow-up care, even though clinics handle those visits differently. By tracking more than 53,000 follow-up appointments over time, the Children's National team was able to see how several changes worked together in a real-world clinic.

"What excites me most is that we found a clear, measurable relationship between how care is delivered and whether patients actually make it to follow-up," said Ayman Saleh, MD, MBA, one of the study authors and a child and adolescent psychiatrist at Children's National. "Greater telehealth use was independently associated with lower missed appointment rates, and overall missed visits fell by half over the study period, suggesting that practical operational changes can meaningfully improve continuity and access to care."

The patient benefit

For young patients and their families, fewer missed visits can mean fewer breaks in treatment and more consistent support. Better attendance also helps clinics use their limited appointment time more effectively, creating more opportunities for other children who need care. While this study focused on behavioral health, the same approach could be useful in other outpatient specialties facing similar access challenges.

Additional authors from Children's National include Mark DiFazio, MD, MBA, and Adelaide Robb, MD.

Read the full study, Multicomponent Operational Strategies to Support Follow-up Attendance in Child and Adolescent Psychiatry: A Longitudinal Evaluation, in the Journal of Ambulatory Care Management.