Challenges to Effective Primary Care-Specialty Communication and Coordination in the Mental Health Referral and Care Process for Publicly Insured Children

  • Lorena Porras-Javier
  • Elizabeth Bromley
  • Maria Lopez
  • Tumaini R. CokerEmail author


Publicly insured children needing referral to mental health (MH) services often do not access or receive services. The objective of this study was to identify gaps in communication and coordination between primary care providers (PCPs) and MH providers during the MH referral and care process for publicly insured children. Thirteen semi-structured interviews were conducted with 10 PCPs and staff from a federally qualified health center (FQHC) and 6 MH providers and staff from two local MH clinics. Interview participants identified multiple gaps in communication throughout the care process and different phases as priorities for improvement. PCPs described primary care-MH communication challenges during early phases, while MH providers described coordination challenges in transferring patients back to primary care for ongoing mental health management. Strategies are needed to improve primary care-specialty MH communication and coordination throughout all phases of the referral and care process, particularly at initial referral and transfer back to primary care.


Primary care Mental health care Coordination Collaboration 



Mental health


Federally qualified health center


Funding Sources

This work was supported through a Patient-Centered Outcomes Research Institute (PCORI) Award (IH-12-11-4168) and a grant from the California Community Foundation (CCF) Award (BAPP-14-107,111). All statements in this report, including its findings and conclusions, are solely those of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors or Methodology Committee.

Compliance with Ethical Standards

Conflicts of Interest

The authors declare that they have no conflict of interest.


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Copyright information

© National Council for Behavioral Health 2018

Authors and Affiliations

  • Lorena Porras-Javier
    • 2
  • Elizabeth Bromley
    • 3
  • Maria Lopez
    • 2
  • Tumaini R. Coker
    • 1
    Email author
  1. 1.Seattle Children’s Research InstituteSeattleUSA
  2. 2.UCLA Children’s Discovery and Innovation InstituteGeffen School of Medicine at UCLALos AngelesUSA
  3. 3.Psychiatry and Biobehavioral SciencesGeffen School of Medicine at UCLALos AngelesUSA

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