Supporting child psychiatric services using current managed care approaches: you can't get there from here

Addressing Early Childhood Emotional and Behavioral Problems

More than 10% of young children experience clinically significant mental health problems, with rates of impairment and persistence comparable to those seen in older children. For many of these clinical disorders, effective treatments supported by rigorous data are available. On the other hand, rigorous support for psychopharmacologic interventions is limited to 2 large randomized controlled trials. Access to psychotherapeutic interventions is limited. The pediatrician has a critical role as the leader of the medical home to promote well-being that includes emotional, behavioral, and relationship health. To be effective in this role, pediatricians promote the use of safe and effective treatments and recognize the limitations of psychopharmacologic interventions. This technical report reviews the data supporting treatments for young children with emotional, behavioral, and relationship problems and supports the policy statement of the same name.

Community Introduction of Practice Parameters for Autistic Spectrum Disorders: Advancing Early Recognition

OBJECTIVES

Within a strong interdisciplinary framework, improvement in the quality of care for children with autistic spectrum disorders through a 2 year implementation program of Practice Parameters, aimed principally at improving early detection and intervention.

METHOD

We developed Practice Parameters (PPs) for Pervasive Developmental Disorders and circulated the PPs to all child and adolescent psychiatrists practicing in the region.

RESULTS

PP development and parallel information strategies resulted in a significant decrease of 1.5 years in the mean-age-at-diagnosis. However, further analysis indicated that improvement was only transient.

CONCLUSION

Despite the encouraging improvement in mean-age-at-diagnosis 2 years after PP implementation, other indicators showed a failure to maintain the improvements. A systematic screening program would be the most reliable method to reinforce the PPs.

The impact of managed behavioral health care on youth in the juvenile justice system

The purpose of this study was to describe how managed behavioral health care affects youth in the juvenile justice system with behavioral health disorders. A multiple case study consisting of 30 semistructured interviews of officials in the local, state, and federal juvenile justice system was performed. The study found that agreement exists among officials that managed behavioral health care acts as a barrier to behavioral health care for juvenile justice youth. A major conclusion of the study was that the relinquishment of youth custody to the state for the purpose of accessing behavioral services must cease.

The impact of managed care on children's outpatient treatment: a comparison study of treatment outcome before and after managed care

This study examined treatment outcome pre- and post-managed care in 3 samples of patients (N = 885; ages 5 to 18 years) at an urban-based children's psychiatric outpatient clinic. Although the post-managed care groups were seen for fewer sessions than the pre-managed care group, there was no difference between the pre- and post-managed care groups in clinical outcome.

The evolution of systems of care for children's mental health: forty years of community child and adolescent psychiatry

Over the past 20 years, child and adolescent community mental health has evolved conceptually, clinically, and scientifically towards the community-based systems of care model. This model asserts important values and principles, including the centrality of the child and family in the care process, the integration of the efforts of disparate agencies and interveners into a contextual approach, and the importance of serving children with serious disturbances in their homes and communities. The article reviews the evolution of the community-based systems of care model, its evidence-base, its application in practice, and the challenges it faces in today's human services environment.

Utility of psychosocial screening at a school-based health center

School-based health centers (SBHC) have substantial potential to improve the recognition and treatment of adolescents' mental health problems. This study was undertaken as a quality improvement project to evaluate utility of the Pediatric Symptom Checklist when completed by youth (PSC-Y) among 383 adolescents seen at a SBHC, and the extent to which identification of psychosocial dysfunction and referral to mental health services improved academic functioning. Adolescents identified by the PSC-Y were significantly more likely to be insured by Medicaid, be a teen-age parent, and to have higher rates of absenteeism and tardiness in comparison to those not identified. Adolescents identified with the PSC-Y who were referred to mental health services significantly decreased their rates of absences and tardiness. Study results provide support for the utility of psychosocial screening and referral in the SBHC environment in facilitating recognition and treatment of adolescent mental health problems and improving student academic functioning.

The collaboration between psychiatry and primary care in managed care

Primary care physicians have an important historical role in the delivery of mental health care despite the evolution of psychiatry as a specialty. Collaboration between primary care physicians and psychiatrists has been limited by problems of access to psychiatric care or consultation. Although managed care, in some forms, has been successful in addressing this issue, it has largely served as a new barrier to effective collaboration and to meeting the mental health care needs of patients.