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Objectives: Texas Child Health Access Through Telemedicine (TCHATT) delivers behavioral health telehealth services statewide for children and adolescents. To support consistent, high-quality care, program leadership adopted standards for measurement-based care (MBC) across 12 academic medical centers (750+ clinicians/staff and 57,000+ enrolled students to date). Initial MBC implementation began with the Columbia Impairment ScaleParent Version (CIS-P) in January 2023, with program personnel manually assigning the CIS-P through the workflow platform. In January 2024, TCHATT launched an automated system to assign, score, and schedule evidencebased rating scales (EBRS). This evaluation assessed the impact of automation on standardizing MBC practices. Methods: We analyzed 3 indicators: 1) proportion of CIS-P assessments completed prior to the intake visit; 2) proportion of completed CIS-P assessments submitted the same day they were sent; and 3) days to completion among students who completed the CIS-P after the day it was sent. Systemgenerated administrative data (January 2023-March 2025, aggregated quarterly) were used. Logistic regression modeled completion prior to intake and same-day completion; linear regression on log-transformed days modeled time to completion among non–same-day completers. Robust standard errors adjusted for site-level clustering. Results: Among 37,577 CIS-P assessments assigned, 28,506 (75.9%) were completed. The odds of completing CIS-P prior to intake increased substantially from 2023 Q1 to 2025 Q2 (OR = 9.9; 95% CI. 6.4-15.1). Proportion completed rose to 88% by 2024 Q3 and remained there with some seasonality related to the school calendar. The odds of same-day completion also rose markedly and leveled off, peaking in 2024 Q3 (OR = 3.1; 95% CI, 1.4-7.0). Among students with delayed completion, average time to completion declined by 40% by 2025 Q2 compared to 2023 Q1 (exp [β] = .60; 95% CI, 0.46-0.79). Conclusions: Automating EBRS delivery improved the consistency and timeliness of MBC, increasing both completion and same-day response rates. Completion and timeliness reached a high level and remained stable, with some seasonality. As of February 2025, the automation expanded to assign a broader set of EBRS and trigger follow-up measures based on screening results.
Citation: Williams L, Koch A, Feinstein C 6.7 Quality Improvement to Standardize Measurement-Based Care in a Statewide Student Telehealth Program Journal of the American Academy of Child & Adolescent Psychiatry, 64S307
