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Prichett LM, Yolken RH, Severance EG, Young AS, Carmichael D, Zeng Y, Kumra T. Racial and Gender Disparities in Suicide and Mental Health Care Utilization in a Pediatric Primary Care Setting. J Adolesc Health 2024; 74:277-282. [PMID: 37815762 PMCID: PMC10842072 DOI: 10.1016/j.jadohealth.2023.08.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/12/2023] [Accepted: 08/24/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE We examined racial and gender disparities in the underrecognition of mental health disorders in adolescents and young adults as defined by a suicide-related diagnosis without a previous mental or behavioral health diagnosis. METHODS We employed a series of adjusted mixed multilevel logistic regression models to determine the odds of specific mental health diagnoses (anxiety, depression, and suicide-related) in a large, U.S. pediatric ambulatory care group (ages 8-20 years) using Electronic Medical Record Data. RESULTS Using the reference group of White males, White females had 17% increased odds of having a suicide-related diagnosis (odds ratio (OR) 1.17, 95% confidence intervals (CI) 1.03, 1.34) and Black females had 48% increased odds of suicide-related diagnosis (OR 1.48, 95% CI 1.28, 1.71). Conversely, White females had 75% increased odds of recorded anxiety (OR 1.75, 95% CI 1.62, 1.89), Black males had 62% decreased odds of anxiety (OR 0.38, 95% CI 0.33, 0.42), and Black females had 33% decreased odds of anxiety (OR 0.67, 95% CI 0.60, 0.74). White females had 81% increased odds of having recorded depression (OR 1.81, 95% CI 1.62, 2.04) and Black females had 80% increased odds of underrecognized need for mental or behavioral health diagnosis services (OR 1.80, 95% CI 1.53, 2.13) as defined by a suicide-related diagnosis without a previous mental health diagnosis. DISCUSSION Black adolescents and young adult patients are either not accessing or identified as needing mental health services at the same rates as their White peers, and Black females are experiencing the most underrecognition of need for mental health services.
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Affiliation(s)
- Laura M Prichett
- Division of General Pediatrics, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Robert H Yolken
- Stanley Division of Developmental Neurovirology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Emily G Severance
- Stanley Division of Developmental Neurovirology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Andrea S Young
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Destini Carmichael
- Division of General Pediatrics, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Yong Zeng
- Division of General Pediatrics, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Tina Kumra
- Division of General Pediatrics, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
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Young AS, Findling RL, Riehm KE, Seegan P, Crum RM, Mojtabai R, Chiappini EA, Youngstrom EA, Fristad MA, Arnold LE, Birmaher B, Horwitz SM. Adequacy of Children's Psychopharmacology Services: Variations by Race and Clinical Characteristics. Psychiatr Serv 2023; 74:1218-1226. [PMID: 37287230 PMCID: PMC10983772 DOI: 10.1176/appi.ps.20220375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE An expert consensus approach was used to determine the adequacy of children's psychopharmacology and to examine whether adequacy varied by demographic or clinical characteristics. METHODS Data were from the baseline interview of 601 children, ages 6-12 years, who had visited one of nine outpatient mental health clinics and participated in the Longitudinal Assessment of Manic Symptoms study. Children and parents were interviewed with the Kiddie Schedule for Affective Disorders and Schizophrenia and the Service Assessment for Children and Adolescents to assess the child's psychiatric symptoms and lifetime mental health services use, respectively. An expert consensus approach informed by published treatment guidelines was used to determine the adequacy of children's psychotropic medication treatment. RESULTS Black children (compared with White children; OR=1.84, 95% CI=1.53-2.23) and those with anxiety disorders (vs. no anxiety disorder; OR=1.55, 95% CI=1.08-2.20) were more likely to receive inadequate pharmacotherapy; those whose caregivers had a bachelor's degree or more education (vs. those who had a high school education, general equivalency diploma, or less than high school education; OR=0.74, 95% CI=0.61-0.89) were less likely to receive inadequate pharmacotherapy. CONCLUSIONS The consensus rater approach permitted use of published treatment efficacy data and patient characteristics (e.g., age, diagnoses, history of recent hospitalizations, and psychotherapy) to assess adequacy of pharmacotherapy. These results replicate findings of racial disparities reported in previous research using traditional methods to determine treatment adequacy (e.g., with a minimum number of treatment sessions) and highlight the continued need for research on racial disparities and strategies to improve access to high-quality care.
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Affiliation(s)
- Andrea S Young
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Robert L Findling
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Kira E Riehm
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Paige Seegan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Rosa M Crum
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Ramin Mojtabai
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Erika A Chiappini
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Eric A Youngstrom
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Mary A Fristad
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - L Eugene Arnold
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Boris Birmaher
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Sarah M Horwitz
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
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Williams NJ, Beauchemin J, Griffis J, Marcus SC. Disparities in Youth and Family Experiences of System-of-Care Principles by Level of Youth Need. Community Ment Health J 2023; 59:1388-1400. [PMID: 37084106 PMCID: PMC10119524 DOI: 10.1007/s10597-023-01126-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 03/30/2023] [Indexed: 04/22/2023]
Abstract
The extent to which mental health services for youths embody system-of-care (SOC) principles is an important quality indicator. This study tested whether youth and family experiences of SOC principles varied depending on youths' level of need after adjusting for sociodemographic and treatment factors. The relationship to caregiver-reported clinical outcomes was also examined. Using administrative data and cross-sectional surveys from a stratified random sample of 1124 caregivers of youths ages 5-20 within a statewide system, adjusted analyses indicated caregivers of youths with the most intensive needs were significantly less likely to report receiving care that embodied SOC principles, with deficits on six of nine items. Youths whose services embodied SOC principles experienced significantly greater improvement in caregiver-reported functioning even after adjusting for level of need. Results highlight disparities in SOC principles for youths with intensive needs and the need for policy and intervention development to improve care for this population.
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Affiliation(s)
- Nathaniel J. Williams
- School of Social Work, Boise State University, 1910 W. University Drive, Boise, ID 83725 USA
- Institute for the Study of Behavioral Health and Addiction, Boise State University, Boise, ID 83725 USA
| | - James Beauchemin
- School of Social Work, Boise State University, 1910 W. University Drive, Boise, ID 83725 USA
| | - Jennifer Griffis
- College of Professional Studies, Northeastern University, 360 Huntington Ave, Boston, MA 02115 USA
| | - Steven C. Marcus
- School of Social Policy and Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA 19104 USA
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4
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Yu-Lefler HF, Hsu YJ, Sen A, Marsteller J. Service Utilization for Parent Management of Early Childhood Behavior Problems in a Private Outpatient Behavioral Clinic: The Impact of Out-of-Pocket Cost, Travel Distance, and Initial Treatment Progress. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:834-847. [PMID: 37382741 DOI: 10.1007/s10488-023-01282-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2023] [Indexed: 06/30/2023]
Abstract
Poorly-managed early childhood disruptive behavior disorders (DBDs) have costly psychological and societal burdens. While parent management training (PMT) is recommended to effectively manage DBDs, appointment adherence is poor. Past studies on influential factors of PMT appointment adherence focused on parental factors. Less well studied are social drivers relative to early treatment gains. This study investigated how financial and time cost relative to early gains influence PMT appointment adherence for early childhood DBDs in a clinic of a large behavioral health pediatric hospital from 2016 to 2018. Using information obtained from the clinic's data repository, claims records, public census and geospatial data, we assessed how owed unpaid charges, travel distance from home to clinic, and initial behavioral progress influences total and consistent attendance of appointments for commercially- and publicly-insured (Medicaid and Tricare) patients, controlling for demographic, service, and clinical differences. We further assessed how social deprivation interacted with unpaid charges to influence appointment adherence for commercially-insured patients. Commercially-insured patients had poorer appointment adherence with longer travel distances, or having unpaid charges and greater social deprivation; they also attended fewer total appointments with faster behavioral progress. Comparatively, publicly-insured patients were not affected by travel distance and had higher consistent attendance with faster behavioral progress. Longer travel distance and difficulty paying service costs while living in greater social deprivation are barriers to care for commercially-insured patients. Targeted intervention may be needed for this specific subgroup to attend and stay engaged in treatment.
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Affiliation(s)
- Helen Fan Yu-Lefler
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Department of Behavioral Psychology, Kennedy Krieger Institute, 707 North Broadway, Baltimore, MD, 21205, USA.
- Bureau of Primary Health Care, Health Resources and Services Administration, 5600 Fishers Lane, Rockville, MD, 20852, USA.
| | - Yea-Jen Hsu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Aditi Sen
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- The Health Care Cost Institute, Washington, DC, USA
| | - Jill Marsteller
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins School of Medicine, Baltimore, MD, USA
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5
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Hurd NM, Young AS. Introduction to the Special Issue: Advancing Racial Justice in Clinical Child and Adolescent Psychology. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:311-327. [PMID: 37141558 PMCID: PMC10213141 DOI: 10.1080/15374416.2023.2202255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Relative to White youth, racially and ethnically marginalized youth in the U.S. are less likely to initiate treatment, stay in treatment, and receive adequate care. This special issue attends to racial injustice in clinical child and adolescent psychology. While numerous factors drive these racial disparities, this special issue focuses specifically on opportunities and responsibilities we have as mental health providers, teachers, mentors, researchers, and gatekeepers to make our field more racially just. In this introduction to the special issue, we review barriers and solutions across multiple contexts including structural, institutional, and practice-based. We also discuss challenges and opportunities to diversify our field and increase the representation of racially and ethnically marginalized practitioners and scholars in clinical child and adolescent psychology. We then briefly review the special issue articles and make final recommendations for how to move the field forward.
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Affiliation(s)
| | - Andrea S Young
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine
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6
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Becker KD, Chorpita BF. Future Directions in Youth and Family Treatment Engagement: Finishing the Bridge Between Science and Service. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:284-309. [PMID: 36787342 DOI: 10.1080/15374416.2023.2169926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
The field has spent more than 50 years investing in the quality of youth mental healthcare, with intervention science yielding roughly 1,300 efficacious treatments. In the latter half of this period, concurrent efforts in implementation science have developed effective methods for supporting front-line service organizations and therapists to begin to bridge the science to service gap. However, many youths and families still do not benefit fully from these strategic investments due to low treatment engagement: nearly half of youths in need of services pursue them, and among those who do, roughly another half terminate prematurely. The negative impact of low engagement is substantial, and is disproportionally and inequitably so for many. We contend that to build a robust and "finished" bridge connecting science and service, the field must go beyond its two historical foci of designing interventions and preparing therapists to deliver them, to include an intentional focus on the youths and families who participate in these interventions and who work with those therapists. In this paper, we highlight the significance of treatment engagement in youth mental healthcare and discuss the current state of the literature related to four priorities: conceptualization, theory, measurement, and interventions. Next, we offer an example from our own program of research as one illustration for advancing these priorities. Finally, we propose recommendations to act on these priorities.
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Dir AL, Pederson CA, Ouyang F, Monahan PO, Schwartz K, Wiehe SE, Aalsma MC. Examining Patterns of Psychotherapy Service Utilization Among Medicaid-Enrolled Adolescents. Psychiatr Serv 2023; 74:374-380. [PMID: 36597697 DOI: 10.1176/appi.ps.202100513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Adolescents with behavioral health disorders (i.e., mental health disorders and substance use) often experience frequent recurrence of symptoms, suggesting a need for an ongoing behavioral health intervention, rather than a single course of treatment. However, little is known about mental health care service use among adolescents over longer periods. The authors examined longitudinal patterns of outpatient behavioral health service utilization in a large sample of adolescents. METHODS Medicaid claims for 8,197 adolescents (ages 10.0-13.9 years, mean±SD=11.5±1.2; 61% male) from one Indiana county between 2006 and 2017 were examined, with a focus on outpatient psychotherapy visits. Latent class analysis (LCA) was used to detect clusters of longitudinal patterns of outpatient psychotherapy visits across 5 years, beginning with an adolescent's first behavioral health visit. RESULTS A five-class LCA model emerged with unique classes of service use based on duration and level of engagement (frequency) of monthly outpatient psychotherapy visits. Most adolescents fell in the nonuse class (38.7% of the sample). Additional classes were defined as late-onset low engagement (17.1%), early-onset high engagement (15.5%), early-onset moderate engagement (16.7%), and continuously high engagement (11.9%). Statistically significant differences were found across the classes in average duration and frequency of involvement (p<0.001), as well as in demographic characteristics (race, age, gender, and ethnicity) and behavioral health diagnoses (p<0.001). CONCLUSIONS These findings confirm that adolescents with behavioral health diagnoses do not follow a uniform pattern of psychotherapy utilization. The distinct patterns of service use point toward the need to identify appropriate long-term service recommendations for adolescents.
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Affiliation(s)
- Allyson L Dir
- Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis
| | - Casey A Pederson
- Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis
| | - Fangqian Ouyang
- Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis
| | - Patrick O Monahan
- Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis
| | - Katherine Schwartz
- Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis
| | - Sarah E Wiehe
- Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis
| | - Matthew C Aalsma
- Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis
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Sullivan DP, Payne L, Boulton KA, Silove N, Bellgrove MA, Sciberras E, Coghill DR, Guastella AJ, Middeldorp CM. Examining the pharmacological and psychological treatment of child and adolescent ADHD in Australia: Protocol for a retrospective cohort study using linked national registry data. BMJ Open 2022; 12:e064920. [PMID: 36418141 PMCID: PMC9685201 DOI: 10.1136/bmjopen-2022-064920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder which affects 5% of children globally. In Australia, it is estimated that 4.1% of children and adolescents have ADHD. While research has examined the treatment and outcomes of children with ADHD attending public mental health services during their time in the public system in Australia, it is not known what treatment they received before and after these treatment episodes, which will provide a more complete understanding of these children's treatment journey. METHODS AND ANALYSIS We will link clinical data from cohorts of children and adolescents treated in the public child and youth mental health and/or child development services in Brisbane, Melbourne and Sydney to the Medicare Benefits Schedule (MBS), Pharmaceutical Benefits Scheme (PBS) and National Death Index. MBS data will demonstrate the treatment journey with respect to clinicians seen, and treatment episodes from the public health service data sets will be examined to assess if the type and intensity of treatment are related to treatment outcomes. PBS data will reveal all psychotropic medications prescribed, allowing an examination of not just ADHD medications, but also other psychotropics which may indicate co-occurring conditions (eg, anxiety and mood disorders). Statistical analyses will include descriptive statistics to describe the rates of specific medications and clinician specialties seen. Linear and logistic regression will be used to model how treatment and sociodemographic variables relate to routinely collected outcome measures in the public health system while controlling for covarying factors. ETHICS AND DISSEMINATION This study has been approved by the following institutional ethics committees: (1) Children's Health Queensland Hospital and Health Service (HREC/21/QCHQ/76260), (2) The University of Queensland (2021/HE002143) and (3) The Australian Institute of Health and Welfare (EO2021/4/1300). Findings will be disseminated through peer-reviewed journals, conferences, professional associations and to public mental health services that treat ADHD.
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Affiliation(s)
- Daniel P Sullivan
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
- Child and Youth Mental Health Service, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Leanne Payne
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
- Child and Youth Mental Health Service, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Kelsie A Boulton
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Clinic for Autism and Neurodevelopmental (CAN) Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Natalie Silove
- Child Development Unit, The Sydney Children's Hospitals Network Randwick and Westmead, Westmead, New South Wales, Australia
| | - Mark A Bellgrove
- Turner Institute for Brain and Mental Health, School of Psychological Science, Monash University, Clayton, Victoria, Australia
| | - Emma Sciberras
- School of Psychology, Deakin University, Burwood, Victoria, Australia
- Deakin University Centre for Social and Early Emotional Development, Burwood, Victoria, Australia
| | - David R Coghill
- Departments of Paediatrics and Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
- The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Adam J Guastella
- Clinic for Autism and Neurodevelopmental (CAN) Research, The University of Sydney, Sydney, New South Wales, Australia
- Clinical Research Unit, Brain and Mind Research Institute, Camperdown, New South Wales, Australia
| | - Christel M Middeldorp
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
- Child and Youth Mental Health Service, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
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9
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How Do Treatment Protocols Affect the Use of Engagement Practices in Youth Mental Health Services? ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:943-961. [PMID: 35920954 DOI: 10.1007/s10488-022-01210-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 06/24/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE Treatment engagement poses challenges for youth mental health providers. With the expansion of evidence-based treatments (EBTs), providers face complex decisions regarding how to engage youth and families using available information sources. This study investigated how EBT protocols are associated with the selection and delivery of engagement practices. METHOD Twenty engagement practices were coded in a sample of digital recordings of early treatment sessions (N = 193) from the Child STEPs in California study, a randomized trial testing modular treatment and community-implemented treatment for youth mental health problems. Data were collected on which protocols mental health providers reportedly used to guide their sessions and the protocols in which they had received training. We examined which information sources (i.e., the guiding protocol, other protocols in training history, unspecified source) were associated with observed engagement practices. RESULTS In sessions guided by a protocol, most observed engagement practices were accounted for by the guiding protocol (p < .001), rather than protocols in training history or unspecified sources (p < .001). In sessions not guided by a protocol, most observed practices were accounted for by training history (p < .001). Practice frequency and extensiveness was generally greater when a protocol guided the session. CONCLUSIONS Inclusion in protocols is associated with the selection and delivery of engagement practices, but this strategy might be insufficient for supporting the use of the full range of engagement practices supported by evidence. Supports are needed that leverage the engagement evidence base to ensure that selected practices empirically fit the engagement needs of youth and families.
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10
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Weersing VR, Gonzalez A, Hatch B, Lynch FL. Promoting Racial/Ethnic Equity in Psychosocial Treatment Outcomes for Child and Adolescent Anxiety and Depression. PSYCHIATRIC RESEARCH AND CLINICAL PRACTICE 2022; 4:80-88. [PMID: 36177440 PMCID: PMC9477232 DOI: 10.1176/appi.prcp.20210044] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 05/26/2022] [Accepted: 07/05/2022] [Indexed: 12/01/2022] Open
Abstract
Anxiety and depression are the most prevalent and least treated pediatric mental health problems. Racial/ethnic minority youths face greater risks for developing anxiety and depression and experience higher burden as they are less likely to receive adequate mental health services for these conditions or to have their needs met. Further, standard evidence‐based interventions for youth anxiety and depression may show diminished effects with racial/ethnic minority youths and with families of lower socioeconomic status. While community‐level interventions to combat structural racism and reduce population‐level risk are sorely needed, many youths will continue to require acute treatment services for anxiety and depression and interventionists must understand how to bring equity to the forefront of care. In this review, we adopt a health system framework to examine racial/ethnic disparities in system‐, intervention‐, provider‐, and patient‐level factors for psychosocial treatment of pediatric anxiety and depression. Current evidence on disparities in access and in efficacy of psychosocial intervention for anxious and depressed youths is summarized, and we use our work in primary care as a case example of adapting an intervention to mitigate disparities and increase equity. We conclude with recommendations for disparity action targets at each level of the health system framework and provide example strategies for intervening on these mechanisms to improve the outcomes of racial/ethnic minority youths. Racial/ethnic minority youths face greater risks for developing anxiety and depression and experience higher burden from disorder as they are less likely to receive adequate mental health services for these conditions or to have their needs met. Increasing access to services for anxiety and depression is of critical and immediate importance for racial/ethnic minority families. Issues of access may be associated with the physical location of services (e.g., primary care or telehealth) or with barriers of language, income, or financing. Both service settings and research treatment protocols frequently require families of ethnic/racial minority youths to fit themselves to the demands of care, in ways that may not be culturally compatible (e.g., little parent involvement in treatment) or practically feasible (i.e., weekly sessions during parent working hours). Whenever possible, non‐essential aspects of intervention should be freed to match patient preferences and constraints, and interventions for anxiety and depression should be adopted that have broad impacts and options for personalization of goals.
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Affiliation(s)
- V. Robin Weersing
- SDSU‐UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA (V. R. Weersing); California State University Long Beach, Long Beach, California, USA (A. Gonzalez); OCHIN Research, Oregon Health Sciences University (B. Hatch); OCHIN Research, Kaiser Permanente Center for Health Research, Portland, Oregon, USA (F. L. Lynch)
| | - Araceli Gonzalez
- SDSU‐UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA (V. R. Weersing); California State University Long Beach, Long Beach, California, USA (A. Gonzalez); OCHIN Research, Oregon Health Sciences University (B. Hatch); OCHIN Research, Kaiser Permanente Center for Health Research, Portland, Oregon, USA (F. L. Lynch)
| | - Brigit Hatch
- SDSU‐UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA (V. R. Weersing); California State University Long Beach, Long Beach, California, USA (A. Gonzalez); OCHIN Research, Oregon Health Sciences University (B. Hatch); OCHIN Research, Kaiser Permanente Center for Health Research, Portland, Oregon, USA (F. L. Lynch)
| | - Frances L. Lynch
- SDSU‐UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA (V. R. Weersing); California State University Long Beach, Long Beach, California, USA (A. Gonzalez); OCHIN Research, Oregon Health Sciences University (B. Hatch); OCHIN Research, Kaiser Permanente Center for Health Research, Portland, Oregon, USA (F. L. Lynch)
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11
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Rodgers CRR, Flores MW, Bassey O, Augenblick JM, Cook BL. Racial/Ethnic Disparity Trends in Children's Mental Health Care Access and Expenditures From 2010-2017: Disparities Remain Despite Sweeping Policy Reform. J Am Acad Child Adolesc Psychiatry 2022; 61:915-925. [PMID: 34627995 PMCID: PMC8986880 DOI: 10.1016/j.jaac.2021.09.420] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 09/08/2021] [Accepted: 09/30/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To examine trends in mental health care use for Black and Latinx children and adolescents. METHOD Data from the Medical Expenditure Panel Survey for 2010-2017 were analyzed to assess trends among youth ages 5-17 in use and expenditures for any mental health care, outpatient mental health care, and psychotropic medication prescription fills. Unadjusted trends for all youth and the subpopulation of youth reporting need for mental health care and disparities adjusting for need were examined. RESULTS Between 2010 and 2017, Black youth rates of any past year mental health care use decreased (from 9% to 8%), while White (from 13% to 15%) and Latinx (from 6% to 8%) youth rates increased. Among the subpopulation with need and in regression analysis adjusting for need, we identified significant Black-White and Latinx-White disparities in any mental health care use and any outpatient mental health care use in 2010-2011 and 2016-2017, with significant worsening of Black-White disparities over time. White youth were more than twice as likely as Latinx youth to use psychotropic medications, and Latinx-White and Black-White disparities in psychotropic medication prescription fills persisted over time. Black-White disparities existed in overall mental health expenditures (2016-2017) and outpatient mental health expenditures (2010-2011 and 2016-2017). CONCLUSION Affordable, ubiquitous access to mental health care for Black and Latinx youth remains an elusive target. Significant disparities exist in receiving mental health care despite reforms and policies designed to increase mental health care access in the general population. Additional outreach and treatment strategies tailored to the cultural, linguistic, and structural needs of youth of color are required.
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Affiliation(s)
| | - Michael William Flores
- Harvard Medical School, Boston, Massachusetts; Health Equity Research Laboratory, Cambridge Health Alliance, Cambridge, Massachusetts
| | | | | | - Benjamin Lê Cook
- Albert Einstein College of Medicine, Bronx, New York; Harvard Medical School, Boston, Massachusetts; Health Equity Research Laboratory, Cambridge Health Alliance, Cambridge, Massachusetts
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12
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Yusuf HE, Copeland-Linder N, Young AS, Matson PA, Trent M. The Impact of Racism on the Health and Wellbeing of Black Indigenous and Other Youth of Color (BIPOC Youth). Child Adolesc Psychiatr Clin N Am 2022; 31:261-275. [PMID: 35361364 DOI: 10.1016/j.chc.2021.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Black, Indigenous, and other Youth of Color (BIPOC youth) experience racism from a young age. These experiences have both immediate and long-term impacts on their health and wellbeing. Systemic racism contributes to the inequitable distribution of health resources and other social determinants of health, creating barriers to accessing care. Substance use disorders and sexual/nonsexual risk behaviors have been linked to experiences of racism in BIPOC youth. The legacy of generational racial trauma can frame behaviors and attitudes in the present, undermining health and survival in this group. BIPOC youth also face difficulties navigating spheres characterized as white spaces. Ethnic-racial socialization may promote resilience and help with coping in the context of racial stress. While many professional health organizations have embraced dismantling racism, a shift in the narrative on racial values will be critical for preventing adversity and achieving health equity for BIPOC youth.
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Affiliation(s)
- Hasiya E Yusuf
- Department of Pediatrics, Johns Hopkins University School of Medicine, Johns Hopkins University, 200 N Wolfe Street, Baltimore, MD 21287, USA.
| | - Nikeea Copeland-Linder
- Department of Psychiatry and Behavioral Sciences, Kennedy Krieger Institute, Johns Hopkins School of Medicine, 600 N Wolfe Street, Baltimore, MD 21205, USA
| | - Andrea S Young
- Division of Child and Adolescent Psychiatry, Johns Hopkins School of Medicine, 1800 Orleans Street, Bloomberg 12 N, Baltimore, MD 21287 USA
| | - Pamela A Matson
- Department of Pediatrics, Johns Hopkins University School of Medicine, Johns Hopkins University, 200 N Wolfe Street, Baltimore, MD 21287, USA
| | - Maria Trent
- Department of Pediatrics, Johns Hopkins University School of Medicine, Johns Hopkins University, 200 N Wolfe Street, Baltimore, MD 21287, USA.
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13
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Lui JHL, Brookman-Frazee L, Vázquez AL, Cox JR, Innes-Gomberg D, Taguchi K, Pesanti K, Lau AS. Patterns of Child Mental Health Service Utilization Within a Multiple EBP System of Care. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 49:506-520. [PMID: 34837572 PMCID: PMC9005401 DOI: 10.1007/s10488-021-01179-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 11/09/2022]
Abstract
The current study (1) characterizes patterns of mental health service utilization over 8 years among youth who received psychotherapy in the context of a community implementation of multiple evidence-based practices (EBPs), and (2) examined youth-, provider- and service-level predictors of service use patterns. Latent profile analyses were performed on 5,663,930 administrative claims data furnished by the county department of mental health. Multinomial logistic regression with Vermunt’s method was used to examine predictors of care patterns. Based on frequency, course, cost, and type of services, three distinct patterns of care were identified: (1) Standard EBP Care (86.3%), (2) Less EBP Care (8.5%), and (3) Repeated/Chronic Care (5.2%). Youth age, ethnicity, primary language, primary diagnosis and secondary diagnosis, provider language and provider type, and caregiver involvement and service setting were significant predictors of utilization patterns. Although the majority of youth received care aligned with common child EBP protocols, a significant portion of youth (13.7%) received no evidence-based care or repeated, costly episodes of care. Findings highlight opportunities to improve and optimize services, particularly for youth who are adolescents or transition-aged, Asian-American/Pacific Islander, Spanish-speaking, or presenting with comorbidities.
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Affiliation(s)
- Joyce H L Lui
- Department of Psychology, University of California, Los Angeles, Los Angeles, USA.
- Department of Psychology, University of Maryland, College Park, USA.
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, San Diego, USA
- Child and Adolescent Services Research Center, La Jolla, USA
| | | | - Julia R Cox
- Department of Psychology, University of California, Los Angeles, Los Angeles, USA
| | | | - Kara Taguchi
- Los Angeles County Department of Mental Health, Los Angeles, USA
| | - Keri Pesanti
- Los Angeles County Department of Mental Health, Los Angeles, USA
| | - Anna S Lau
- Department of Psychology, University of California, Los Angeles, Los Angeles, USA
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14
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Lakind D, Bradley WJ, Patel A, Chorpita BF, Becker KD. A Multidimensional Examination of the Measurement of Treatment Engagement: Implications for Children's Mental Health Services and Research. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2021; 51:453-468. [PMID: 34269632 DOI: 10.1080/15374416.2021.1941057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: The gap between rates of children's mental health problems and their participation in services highlights the need to address concerns related to engagement in mental health services more effectively. To identify, understand, and resolve engagement concerns appropriately requires effective measurement. In this study, we employed a multidimensional conceptual framework of engagement to examine the measurement of engagement in intervention studies focused on improving children's and/or families' engagement in services.Method: We coded 52 randomized controlled trials (RCTs) of interventions designed to enhance treatment engagement published between 1974 and 2019 to examine what engagement constructs have been measured, how these constructs have been measured, who has provided information about engagement, and when and why engagement measures have been administered.Results: Attendance was measured in 94.2% of studies, and 59.6% of studies measured only attendance. Furthermore, most studies (61.5%) measured only one engagement dimension. One hundred twelve unique indicators of treatment engagement were used (61.6% measuring attendance). Infrequent measurement of youth (19.2% of studies) or caregiver (26.9%) perspectives was apparent. About half (54.7%) of measures were completed on one occasion, with 53.7% of measures completed after treatment was concluded.Conclusions: Results highlight how the field's measurement of engagement has focused narrowly on attendance and on interventions that improve attendance. We consider promising new directions for capturing the multidimensional, dynamic, and subjective aspects of engagement, and for leveraging measurement in research and practice settings to feasibly and effectively identify, monitor, and address engagement challenges.
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Affiliation(s)
| | | | - Ajay Patel
- College of Medicine, Medical University of South Carolina
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15
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Oostermeijer S, Bassilios B, Nicholas A, Williamson M, Machlin A, Harris M, Burgess P, Pirkis J. Implementing child and youth mental health services: early lessons from the Australian Primary Health Network Lead Site Project. Int J Ment Health Syst 2021; 15:16. [PMID: 33622372 PMCID: PMC7903689 DOI: 10.1186/s13033-021-00440-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 02/10/2021] [Indexed: 11/10/2022] Open
Abstract
AIM Primary mental health care services play an important role in prevention and early intervention efforts to reduce the prevalence and impact of mental health problems amongst young people. This paper aimed to (1) investigate whether mental health services commissioned by Australia's 31 Primary Health Networks provided accessible care and increasingly reached children and youth across Australia, and (2) identify the challenges of, and facilitating factors to, implementing services for youth with, or at risk of, severe mental illness (i.e., youth enhanced services) in 10 PHNs which acted as mental health reform leaders (i.e., Lead Sites). METHODS We used mixed methods, sourcing data from: a national minimum data set that captured information on consumers and the services they received via all 31 PHNs from 1 July 2016 to 31 December 2017; consultations with Lead Site staff and their regional stakeholders; and observational data from two Lead Site meetings. RESULTS Many children and youth receiving services were male and up to 10% were Aboriginal and/or Torres Strait Islander young people. The majority of young people came from areas of greater disadvantage. For most children and youth receiving services their diagnosis was unknown, or they did not have a formal diagnosis. Both child and youth service uptake showed a modest increase over time. Six key themes emerged around the implementation of youth enhanced services: service access and gaps, workforce and expertise, funding and guidance, integrated and flexible service models, service promotion, and data collection, access and sharing. CONCLUSIONS Early findings suggest that PHN-commissioned services provide accessible care and increasingly reach children and youth. Learnings from stakeholders indicate that innovative and flexible service models in response to local youth mental health needs may be a key to success.
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Affiliation(s)
| | | | - Angela Nicholas
- The University of Melbourne, Melbourne, VIC, 3010, Australia
| | | | - Anna Machlin
- The University of Melbourne, Melbourne, VIC, 3010, Australia
| | | | | | - Jane Pirkis
- The University of Melbourne, Melbourne, VIC, 3010, Australia
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16
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Ride J, Huang L, Mulraney M, Hiscock H, Coghill D, Sawyer M, Sciberras E, Dalziel K. Is 'minimally adequate treatment' really adequate? investigating the effect of mental health treatment on quality of life for children with mental health problems. J Affect Disord 2020; 276:327-334. [PMID: 32871663 DOI: 10.1016/j.jad.2020.07.086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/29/2020] [Accepted: 07/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Minimally adequate treatment (MAT) is intended to represent treatment minimally sufficient for common mental health problems. For children, MAT has been defined over a twelve-month period as either eight or more mental health visits, or four to seven visits plus relevant medication. MAT is used to identify those missing out on adequate care, but it is unknown whether MAT improves children's outcomes. METHODS This paper examines whether MAT is associated with improved outcomes for children. It uses survey data from the nationally representative Longitudinal Study of Australian children on 596 children with mental health problems based on the Strengths and Difficulties Questionnaire at ages 8-15 years, linked to health service administrative data from 2012 to 2016. Statistical analysis examines the association of MAT with later quality of life (Pediatric Quality of Life Inventory), using a lagged dependent variable model to account for time-varying unobserved confounding. RESULTS Compared to children with lower levels of treatment, those who received MAT between baseline and follow up had no statistically significant improvement in either quality of life or mental health symptoms. LIMITATIONS The observational data provide insight into real-world practice but require statistical methods to account for selection into treatment. CONCLUSIONS While clinical trials show mental health treatments can be efficacious, this study shows no evidence that children receiving MAT in routine practice have better outcomes. These findings demonstrate the need for better understanding of the nature and impact of children's mental health care as it is delivered and received in routine practice.
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Affiliation(s)
- Jemimah Ride
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Australia.
| | - Li Huang
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Melissa Mulraney
- Murdoch Children's Research Institute, Australia; Department of Paediatrics, University of Melbourne, Australia
| | - Harriet Hiscock
- Murdoch Children's Research Institute, Australia; Department of Paediatrics, University of Melbourne, Australia; Health Services Research Unit, Royal Children's Hospital, Australia
| | - David Coghill
- Department of Paediatrics, University of Melbourne, Australia; Department of Psychiatry, University of Melbourne, Australia
| | | | | | - Kim Dalziel
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Australia
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17
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Abstract
A substantial number of children experience persistent or recurrent problems and may need more than one episode of care. However, there is a paucity of research on recurrent service use. The present study examined the rates and predictors of re-accessing community-based care. Secondary data analyses were conducted on administrative data from 5 mental health agencies in Ontario (N = 1802). Approximately a third (29.6%) of children who had an episode of care re-accessed services again within 4 years; the median time to re-access was 386 days or 12.68 months. Social content (e.g., age, parental marital status) and treatment system (e.g., spacing of visits) variables predicted re-accessing services, although predictors varied based on how services were re-accessed. A better understanding of the factors that influence recurrent service use may help mental health agencies better prepare for and facilitate this process for families.
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18
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Walter HJ, Bukstein OG, Abright AR, Keable H, Ramtekkar U, Ripperger-Suhler J, Rockhill C. Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Anxiety Disorders. J Am Acad Child Adolesc Psychiatry 2020; 59:1107-1124. [PMID: 32439401 DOI: 10.1016/j.jaac.2020.05.005] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/08/2020] [Indexed: 11/20/2022]
Abstract
Anxiety disorders are among the most common psychiatric disorders in children and adolescents. As reviewed in this guideline, both cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitor (SSRI) medication have considerable empirical support as safe and effective short-term treatments for anxiety in children and adolescents. Serotonin norepinephrine reuptake inhibitor (SNRI) medication has some empirical support as an additional treatment option. In the context of a protracted severe shortage of child and adolescent-trained behavioral health specialists, research demonstrating convenient, efficient, cost-effective, and user-friendly delivery mechanisms for safe and effective treatments for child and adolescent anxiety disorders is an urgent priority. The comparative effectiveness of anxiety treatments, delineation of mediators and moderators of effective anxiety treatments, long-term effects of SSRI and SNRI use in children and adolescents, and additional evaluation of the degree of suicide risk associated with SSRIs and SNRIs remain other key research needs.
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19
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Brent DA, Porta G, Rozenman MS, Gonzalez A, Schwartz KTG, Lynch FL, Dickerson JF, Iyengar S, Weersing VR. Brief Behavioral Therapy for Pediatric Anxiety and Depression in Primary Care: A Follow-up. J Am Acad Child Adolesc Psychiatry 2020; 59:856-867. [PMID: 31278996 PMCID: PMC6940557 DOI: 10.1016/j.jaac.2019.06.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 06/12/2019] [Accepted: 06/28/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To report on the 32-week outcome of the Brief Behavioral Therapy (BBT) for Pediatric Anxiety and Depression in Primary Care clinical trial. METHOD A total of 185 youths aged 8 to 17 years with anxiety and/or depression identified through 9 pediatric primary care (PPC) settings in San Diego and Pittsburgh were randomized to receive Assisted Referral to Care (ARC) or up to 12 sessions of BBT over 16 weeks. The primary outcome was clinical response across anxiety and depression, defined as a Clinical Global Impressions-Improvement Score of ≤2. Secondary outcomes included interview-rated functioning, depression, and anxiety. Here, we report on outcomes at 32 weeks after randomization. All analyses with primary outcomes are corrected for multiple comparisons using the false discovery rate procedure. RESULTS At 32 weeks, BBT was superior to ARC with respect to response (67.5% versus 43.1%, q = 0.03, number needed to treat [NNT] = 5) and functioning (d = 0.49, q = 0.04). BBT was superior to ARC with respect to its impact on anxiety (f = 0.21) but not depressive symptoms (f = 0.05). These findings persisted after controlling for the number of sessions received. Ethnicity moderated the impact of BBT on outcome (NNT for Hispanic youths = 2), because of a much lower response rate to ARC in Hispanic than in non-Hispanic youths (16.7% versus 49.2%, p = 0.04). CONCLUSION BBT is a promising intervention that can be effectively delivered in PPC and may be particularly effective for Hispanic patients. Further work is indicated to improve its impact on depressive symptoms and to test BBT against other treatments delivered in pediatric primary care. CLINICAL TRIAL REGISTRATION INFORMATION Brief Cognitive Behavioral Therapy (CBT) for Pediatric Anxiety and Depression in Primary Care; http://clinicaltrials.gov; NCT01147614.
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20
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Yucel A, Sanyal S, Essien EJ, Mgbere O, Aparasu R, Bhatara VS, Alonzo JP, Chen H. Racial/ethnic differences in treatment quality among youth with primary care provider-initiated versus mental health specialist-initiated care for major depressive disorders. Child Adolesc Ment Health 2020; 25:28-35. [PMID: 32285643 DOI: 10.1111/camh.12359] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To compare the racial/ethnic differences in treatment quality among youth with primary care provider-initiated versus mental health specialist-initiated care for major depressive disorders (MDD). METHODS A retrospective cohort study was conducted using the 2005-2007 Medicaid claims data from Texas. Youth aged 10-20 during the study period were identified if they had two consecutive MDD diagnoses and received either medications for MDD or psychotherapy. Patients who received ≥84 days of medications and/or ≥4 sessions of psychotherapy for MDD treatment during 4 months of follow-up were considered meeting the minimum adequacy of treatment. RESULTS The generalized linear multilevel model (MLM) analysis revealed that both Hispanics and Blacks were approximately 30% less likely to receive adequate treatment (Hispanics - OR: 0.67; 95% CI: 0.6-0.8) (Blacks - OR: 0.66; 95% CI: 0.6-0.8) and Hispanic children were 50% more likely to undergo MH-related hospitalization (OR: 1.53; 95% CI: 1.1-2.2) compared to their White counterparts. The odds of meeting the minimum MDD treatment adequacy were comparable between pediatric MDD cases first identified by primary care providers (PCP-I) and psychiatrists (PSY-I) (PCP-I vs. PSY-I: OR: 0.97; 95% CI: 0.8-1.2), and slightly lower in those first identified by social workers/psychologists (SWP-I) as compared to PSY-I (SWP-I vs. PSY-I: OR: 0.81; 95% CI: 0.7-0.9). In all models, the interaction between race/ethnicity and type of provider who initiated MDD care was not statistically significant. CONCLUSIONS Minority youths received less adequate MDD treatment compared to Whites. Hispanic children had the highest risk of having mental health-related hospitalization. The specialty of provider who initiated MDD care had limited impact on treatment quality and was not associated with the racial/ethnic variations in treatment completion and mental health-related hospitalizations.
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Affiliation(s)
- Aylin Yucel
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA
| | - Swarnava Sanyal
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA
| | - Ekere J Essien
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA
| | - Osaro Mgbere
- Bureau of Epidemiology, Houston Health Department, Houston, TX, USA
| | - Rajender Aparasu
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA
| | - Vinod S Bhatara
- Department of Psychiatry, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, USA
| | - Joy P Alonzo
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA
| | - Hua Chen
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA
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21
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Reid GJ, Stewart SL, Barwick M, Carter J, Leschied A, Neufeld RWJ, St Pierre J, Tobon JI, Vingilis E, Zaric GS. Predicting patterns of service utilization within children's mental health agencies. BMC Health Serv Res 2019; 19:993. [PMID: 31870372 PMCID: PMC6929287 DOI: 10.1186/s12913-019-4842-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 12/16/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Some children with mental health (MH) problems have been found to receive ongoing care, either continuously or episodically. We sought to replicate patterns of MH service use over extended time periods, and test predictors of these patterns. METHODS Latent class analyses were applied to 4 years of visit data from five MH agencies and nearly 6000 children, 4- to 13-years-old at their first visit. RESULTS Five patterns of service use were identified, replicating previous findings. Overall, 14% of cases had two or more episodes of care and 23% were involved for more than 2 years. Most children (53%) were seen for just a few visits within a few months. Two patterns represented cases with two or more episodes of care spanning multiple years. In the two remaining patterns, children tended to have just one episode of care, but the number of sessions and length of involvement varied. Using discriminant function analyses, we were able to predict with just over 50% accuracy children's pattern of service use. Severe externalizing behaviors, high impairment, and high family burden predicted service use patterns with long durations of involvement and frequent visits. CONCLUSIONS Optimal treatment approaches for children seen for repeated episodes of care or for care lasting multiple years need to be developed. Children with the highest level of need (severe pathology, impairment, and burden) are probably best served by providing high intensity services at the start of care.
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Affiliation(s)
- Graham J Reid
- Departments of Psychology, Family Medicine, and Paediatrics, The University of Western Ontario, Westminster Hall Room 319E, London, ON, N6A 3K7, Canada.
- Children's Health and Therapeutics, Children's Health Research Institute, London, Canada.
| | - Shannon L Stewart
- Children's Health and Therapeutics, Children's Health Research Institute, London, Canada
- Faculty of Education, The University of Western Ontario, London, Canada
| | - Melanie Barwick
- Research Institute, The Hospital for Sick Children, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- The Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jeffrey Carter
- Quality Improvement, Vanier Children's Services, London, Canada
- Departments of Psychology and Psychiatry, The University of Western Ontario, London, Canada
| | - Alan Leschied
- Faculty of Education, The University of Western Ontario, London, Canada
| | - Richard W J Neufeld
- Departments of Psychology, Psychiatry, and Neuroscience, The University of Western Ontario, London, Canada
| | - Jeff St Pierre
- Departments of Psychology and Psychiatry, The University of Western Ontario, London, Canada
- Child and Parent Resource Institute, London, Canada
| | - Juliana I Tobon
- Department of Psychology, The University of Western Ontario, London, Canada
- St. Michael's Hospital Academic Family Health Team, Toronto, Canada
| | - Evelyn Vingilis
- Departments of Family Medicine and Epidemiology and Biostatistics, The University of Western Ontario, London, Canada
| | - Gregory S Zaric
- Ivey Business School, The University of Western Ontario, London, Canada
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London, Canada
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22
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Walter HJ, Vernacchio L, Trudell EK, Bromberg J, Goodman E, Barton J, Young GJ, DeMaso DR, Focht G. Five-Year Outcomes of Behavioral Health Integration in Pediatric Primary Care. Pediatrics 2019; 144:peds.2018-3243. [PMID: 31186366 DOI: 10.1542/peds.2018-3243] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In the context of protracted shortages of pediatric behavioral health (BH) specialists, BH integration in pediatric primary care can increase access to BH services. The objectives of this study were to assess the structure and process of pediatric BH integration and outcomes in patient experience (access and quality), cost, and provider satisfaction. METHODS In 2013, we launched a multicomponent, transdiagnostic integrated BH model (Behavioral Health Integration Program [BHIP]) in a large pediatric primary care network in Massachusetts. Study participants comprised the first 13 practices to enroll in BHIP (Phase-1). Phase-1 practices are distributed across Greater Boston, with ∼105 primary care practitioners serving ∼114 000 patients. Intervention components comprised in-depth BH education, on-demand psychiatric consultation, operational support for integrated practice transformation, and on-site clinical BH service. RESULTS Over 5 years, BHIP was associated with increased practice-level BH integration (P < .001), psychotherapy (P < .001), and medical (P = .04) BH visits and guideline-congruent medication prescriptions for anxiety and depression (P = .05) and attention-deficit/hyperactivity disorder (P = .05). Total ambulatory BH spending increased by 8% in constant dollars over 5 years, mainly attributable to task-shifting from specialty to primary care. Although an initial decline in emergency BH visits from BHIP practices was not sustained, total emergency BH spending decreased by 19%. BHIP providers reported high BH self-efficacy and professional satisfaction from BHIP participation. CONCLUSIONS Findings from this study suggest that integrating BH in the pediatric setting can increase access to quality BH services while engendering provider confidence and satisfaction and averting substantial increases in cost.
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Affiliation(s)
- Heather J Walter
- Departments of Psychiatry, .,Pediatric Physicians' Organization at Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts; and
| | - Louis Vernacchio
- Pediatric Physicians' Organization at Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts; and.,Pediatrics, and
| | - Emily K Trudell
- Pediatric Physicians' Organization at Children's Hospital, Boston, Massachusetts
| | - Jonas Bromberg
- Departments of Psychiatry.,Pediatric Physicians' Organization at Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts; and
| | - Ellen Goodman
- Pediatric Physicians' Organization at Children's Hospital, Boston, Massachusetts.,Social Work, Boston Children's Hospital, Boston, Massachusetts
| | - Jessica Barton
- Pediatric Physicians' Organization at Children's Hospital, Boston, Massachusetts.,Social Work, Boston Children's Hospital, Boston, Massachusetts
| | - Gregory J Young
- Pediatric Physicians' Organization at Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts; and.,Pediatrics, and
| | - David R DeMaso
- Departments of Psychiatry.,Harvard Medical School, Boston, Massachusetts; and
| | - Glenn Focht
- Connecticut Children's Medical Center, Hartford, Connecticut
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23
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Guo Y, Rousseau J, Hsu AS, Kehoe P, Daviss M, Flores S, Renno P, Saunders K, Phillips S, Evangelista LS. Emotional and Behavioral Health Needs in Elementary School Students in an Underserved Hispanic Community. J Sch Nurs 2019; 35:128-136. [PMID: 28893118 DOI: 10.1177/1059840517726857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
High rates of mental health problems in adolescents have been well documented; less is known about elementary school children in disadvantaged communities. We examined emotional and behavioral health needs in 202 third and fourth graders enrolled in a charter school in a largely Hispanic community. The child-reported Revised Child Anxiety and Depression Scale-25 and Teacher's Report Form were used to evaluate mental health needs as perceived by these children and their teachers. The prevalence of teacher-reported depression and child self-reported anxiety was 7.0% and 6.67%, respectively. Living in a single parent household was found to be a specific risk factor in that those children had higher rates of emotional and behavioral problems than children living with both parents. Evidence of higher depression and anxiety identified in this sample compared to national representative data suggests the need for development of culturally sensitive early prevention and intervention in this underserved community.
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Affiliation(s)
- Yuqing Guo
- 1 Sue & Bill Gross School of Nursing, University of California, Irvine, CA, USA
| | - Julie Rousseau
- 1 Sue & Bill Gross School of Nursing, University of California, Irvine, CA, USA
| | - Anna S Hsu
- 2 Department of Psychology and Social Behavior, University of California, Irvine, CA, USA
| | - Priscilla Kehoe
- 1 Sue & Bill Gross School of Nursing, University of California, Irvine, CA, USA
| | - Monique Daviss
- 3 El Sol Science and Arts Academy of Santa Ana, Santa Ana, CA, USA
| | - Sara Flores
- 3 El Sol Science and Arts Academy of Santa Ana, Santa Ana, CA, USA
| | - Patricia Renno
- 4 Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Kathleen Saunders
- 1 Sue & Bill Gross School of Nursing, University of California, Irvine, CA, USA
| | - Susanne Phillips
- 1 Sue & Bill Gross School of Nursing, University of California, Irvine, CA, USA
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24
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Sawyer MG, Reece CE, Sawyer AC, Hiscock H, Lawrence D. Adequacy of treatment for child and adolescent mental disorders in Australia: A national study. Aust N Z J Psychiatry 2019; 53:326-335. [PMID: 30387377 DOI: 10.1177/0004867418808895] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Worldwide, little information is available about the extent to which children with mental disorders in the general population receive treatment from health professionals that meets minimal clinical practice guidelines. This study identifies the percentage of 6-17 year olds with mental disorders in the 2013-2014 Australian national survey of mental health who had sufficient contact with health professionals during the 18 months after the survey to have received treatment meeting criteria for minimally adequate treatment (MAT). It also identifies factors associated with children having this level of contact with health professionals. METHOD Mental disorders were identified using the Diagnostic Interview Schedule for Children Version IV completed by parents. Health professional attendances and psychotropic medications dispensed were identified from linked national Medicare Benefits Schedule and Pharmaceutical Benefits Scheme records. RESULTS Only 11.6% (95% confidence interval [CI] [9.1, 14.8]) of children with disorders ( n = 517) had sufficient contact to achieve study criteria for MAT. Furthermore, among children with mental disorders who had severe functional impairment and whose parents perceived that their child needed help ( n = 146), 20.2% (95% CI [14.3, 27.9]) had contact sufficient for MAT, 46.0% (95% CI [37.8, 54.4]) had contact that did not achieve MAT criteria and 33.8% (95% CI [26.1, 42.3]) had no contact with health professionals. In multivariable regression, children with moderate or severe functional impairment were more likely to have had sufficient contact to meet MAT criteria. CONCLUSION During the 18 months after being identified with a mental disorder, only a small percentage of children have enough contact with health professionals to allow provision of MAT. This may be contributing to the unchanging high prevalence of childhood mental disorders.
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Affiliation(s)
- Michael G Sawyer
- 1 School of Medicine, The University of Adelaide, North Adelaide, SA, Australia.,2 Research and Evaluation Unit, Women's and Children's Hospital, Women's and Children's Health Network, North Adelaide, SA, Australia
| | - Christy E Reece
- 1 School of Medicine, The University of Adelaide, North Adelaide, SA, Australia.,2 Research and Evaluation Unit, Women's and Children's Hospital, Women's and Children's Health Network, North Adelaide, SA, Australia
| | - Alyssa Cp Sawyer
- 1 School of Medicine, The University of Adelaide, North Adelaide, SA, Australia.,2 Research and Evaluation Unit, Women's and Children's Hospital, Women's and Children's Health Network, North Adelaide, SA, Australia
| | - Harriet Hiscock
- 3 Centre for Community Child Health, The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia.,4 Murdoch Children's Research Institute, Melbourne, VIC, Australia.,5 Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - David Lawrence
- 6 Graduate School of Education, The University of Western Australia, Perth, WA, Australia
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25
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Rich BA, Shiffrin ND, Cummings CM, Zarger MM, Berghorst L, Alvord MK. Resilience-Based Intervention with Underserved Children: Impact on Self-Regulation in a Randomized Clinical Trial in Schools. Int J Group Psychother 2019; 69:30-53. [PMID: 38449213 DOI: 10.1080/00207284.2018.1479187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Resilience and emotion regulation are crucial for optimal psychosocial functioning in children. This study assessed whether a group-based intervention, the Resilience Builder Program (RBP), improved student report of emotion regulation when administered in elementary schools. Sixty-seven students aged 9-12 years (M = 10.50, SD =.74; 82.1% male, 98.5% ethnic/racial minority) were randomly assigned to receive the RBP intervention immediately or following a semester delay. Participants reported their emotional control using the How I Feel scale. Students who received the RBP reported a significant increase in their emotional control and a significant decrease in negative emotion compared to those students in the delayed treatment sample who had not yet received the intervention. Further, students indicated a strongly positive perception of the therapy.
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26
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Sawyer MG, Reece CE, Sawyer AC, Johnson SE, Hiscock H, Lawrence D. Access to health professionals by children and adolescents with mental disorders: Are we meeting their needs? Aust N Z J Psychiatry 2018; 52:972-982. [PMID: 29498290 DOI: 10.1177/0004867418760713] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To identify the percentage of 4-17 year olds with mental disorders in Australia who attended health professionals for single or repeat visits to get help for emotional and behavioural problems during a 12-month period. To identify factors associated with single and repeat visits, and the average length of time between visits. To compare the number of parent-reported visits with visits recorded in the Medicare Benefits Schedule. METHOD The study used data from the national survey of the mental health and wellbeing of 4-17 year olds conducted in 2013-2014 ( n = 6310). Participants were randomly selected from all 4 to 17 year olds in Australia. Information about visits was available from face-to-face interviews with parents, the Medicare Benefits Schedule and self-reports from 13 to 17 year olds. Mental disorders were assessed using the Diagnostic Interview Schedule for Children Version IV completed by parents. RESULTS Parents reported that 51.1% of 4-17 year olds with mental disorders had attended a health professional during the previous 12 months. However, 13.6% of these children had attended on only a single occasion, most commonly with a general practitioner. With the exception of occupational therapists, 2-4 visits was the most common number of repeat visits. Children with comorbid disorders and severe functional impairment and those aged 12-17 years were more likely to have repeat visits. Among those with linked Medicare Benefits Schedule data, more children were reported by parents to have attended Medicare Benefits Schedule-funded health professionals (47.9%) than were recorded in Medicare Benefits Schedule data (38.0%). CONCLUSION The typical number of visits to health professionals by children with mental disorders during a 12-month period is relatively small. Furthermore, parent-reports may overestimate the number of visits during this time. It seems unlikely that current patterns of attendance are of sufficient duration and frequency to allow full implementation of evidence-based treatment programmes for child and adolescent mental disorders.
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Affiliation(s)
- Michael G Sawyer
- 1 Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.,2 Research and Evaluation Unit, Women's and Children's Hospital, Women's and Children's Health Network, North Adelaide, SA, Australia
| | - Christy E Reece
- 1 Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.,2 Research and Evaluation Unit, Women's and Children's Hospital, Women's and Children's Health Network, North Adelaide, SA, Australia
| | - Alyssa Cp Sawyer
- 1 Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.,2 Research and Evaluation Unit, Women's and Children's Hospital, Women's and Children's Health Network, North Adelaide, SA, Australia
| | - Sarah E Johnson
- 3 Telethon Kids Institute, The University of Western Australia, West Perth, WA, Australia
| | - Harriet Hiscock
- 4 Centre for Community Child Health, Royal Children's Hospital, Parkville, VIC, Australia.,5 Murdoch Children's Research Institute, Melbourne, VIC, Australia.,6 Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - David Lawrence
- 7 Graduate School of Education, The University of Western Australia, Perth, WA, Australia
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27
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Parasuraman SR, Anglin TM, McLellan SE, Riley C, Mann MY. Health Care Utilization and Unmet Need Among Youth With Special Health Care Needs. J Adolesc Health 2018; 63:435-444. [PMID: 30078509 DOI: 10.1016/j.jadohealth.2018.03.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 03/15/2018] [Accepted: 03/17/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To examine unmet health needs and health care utilization among youth with special health care needs (YSHCN). METHODS We analyzed data among youth aged 12-17 years using the 2016 National Survey of Children's Health. We conducted descriptive analyses comparing YSHCN with non-YSHCN, and bivariate and multivariable analyses examining associations between dependent and independent measures. Six dependent variables represented unmet needs and utilization. Adjusted analyses controlled for sociodemographic and health measures. RESULTS A total of 5,862 individuals were identified as YSHCN, and nearly 70% had three or more comorbid conditions. Over 90% used medical care, preventive care, or dental care in the past 12 months, while 8% reported having unmet health needs (compared with 2.8% of non-YSHCN). Using a typology of qualifying criteria for special health care needs, we found that YSHCN with increasing complexity of needs were more likely to report unmet health needs, use of mental health care services, and emergency department use, compared with YSHCN using medication only to manage their conditions. All YSHCN living in households below 400% federal poverty level were less likely to utilize nearly all types of health care examined, with the exception of mental health care use, compared with those at or above 400% federal poverty level. CONCLUSIONS Differences in complexity of needs, race/ethnicity, and poverty status highlight existing gaps in health care utilization and persistent unmet health needs among YSHCN. Efforts should focus on strengthening coordinated systems of care that optimally meet the needs of YSHCN so they may thrive in their families and communities.
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Affiliation(s)
- Sarika Rane Parasuraman
- Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland.
| | - Trina M Anglin
- Adolescent Health Branch, Division of Child, Adolescent, and Family Health, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland.
| | - Sarah E McLellan
- Division of Services for Children with Special Health Needs, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland.
| | - Catharine Riley
- Division of Services for Children with Special Health Needs, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland.
| | - Marie Y Mann
- Division of Services for Children with Special Health Needs, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland.
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28
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Yonek JC, Jordan N, Dunlop D, Ballard R, Holl J. Patient-Centered Medical Home Care for Adolescents in Need of Mental Health Treatment. J Adolesc Health 2018; 63:172-180. [PMID: 29887487 PMCID: PMC6113081 DOI: 10.1016/j.jadohealth.2018.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 11/03/2017] [Accepted: 02/08/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE The patient-centered medical home (PCMH) has emerged as an optimal primary care model for all youth; however, little is known about the extent to which adolescents in need of mental health (MH) treatment receive care consistent with the PCMH. This study assessed (1) 10-year trends in PCMH care among U.S. adolescents according to MH need and (2) variations in PCMH care and its subcomponents among adolescents with MH need, by individual and family characteristics. METHODS This was a secondary analysis of Medical Expenditure Panel Survey data (2004-2013). The sample included adolescents aged 12-17 years with ≥1 office-based visits in the past year (N = 18,717). Questions assessing a usual source of care and care that is accessible, comprehensive, family-centered, and compassionate were used to define PCMH care. For adolescents with MH needs, multivariable logistic regression was used to describe the association between PCMH care and sample characteristics. RESULTS Fifty percent of adolescents experienced PCMH care, with little change between 2004 and 2013. Adolescents with MH need (N = 3,794) had significantly lower odds of experiencing PCMH care compared with those without MH need (odds ratio, .78; 95% confidence interval, .69-.87). Among adolescents with MH needs, being uninsured and living with a parent who did not graduate high school were negatively associated with PCMH care, whereas parental usual source of care was positively associated (odds ratio, 1.69; 95% confidence interval, 1.28-2.22). CONCLUSIONS Increasing care accessibility, integrating MH services into primary care settings, and targeting socioeconomically disadvantaged subgroups could improve rates of PCMH care among adolescents with MH needs.
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Affiliation(s)
- Juliet C Yonek
- Department of Psychiatry, Division of Infant, Child, and Adolescent Psychiatry, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California.
| | - Neil Jordan
- Department of Psychiatry & Behavioral Sciences, Department of Preventive Medicine, Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Dorothy Dunlop
- Departments of Medicine and Preventive Medicine, Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Rachel Ballard
- Department of Psychiatry & Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Jane Holl
- Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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29
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Walter HJ, Kackloudis G, Trudell EK, Vernacchio L, Bromberg J, DeMaso DR, Focht G. Enhancing Pediatricians' Behavioral Health Competencies Through Child Psychiatry Consultation and Education. Clin Pediatr (Phila) 2018; 57:958-969. [PMID: 29082768 DOI: 10.1177/0009922817738330] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study was to assess feasibility, utilization, perceived value, and targeted behavioral health (BH) treatment self-efficacy associated with a collaborative child and adolescent psychiatry (CAP) consultation and BH education program for pediatric primary care practitioners (PCPs). Eighty-one PCPs from 41 member practices of a statewide pediatric practice association affiliated with an academic medical center participated in a program comprising on-demand telephonic CAP consultation supported by an extensive BH learning community. Findings after 2 years of implementation suggest that the program was feasible for large-scale implementation, was highly utilized and valued by PCPs, and was attributed by PCPs with enhancing their BH treatment self-efficacy and the quality of their BH care. After participation in the program, nearly all PCPs believed that mild to moderate presentations of common BH problems can be effectively managed in the primary care setting, and PCP consultation utilization was congruent with that belief.
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Affiliation(s)
- Heather J Walter
- 1 Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | | | - Emily K Trudell
- 3 Pediatric Physicians' Organization at Children's, Brookline, MA, USA
| | - Louis Vernacchio
- 1 Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA.,3 Pediatric Physicians' Organization at Children's, Brookline, MA, USA
| | - Jonas Bromberg
- 1 Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA.,3 Pediatric Physicians' Organization at Children's, Brookline, MA, USA
| | - David R DeMaso
- 1 Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | - Glenn Focht
- 3 Pediatric Physicians' Organization at Children's, Brookline, MA, USA
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30
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Williams NJ, Ehrhart MG, Aarons GA, Marcus SC, Beidas RS. Linking molar organizational climate and strategic implementation climate to clinicians' use of evidence-based psychotherapy techniques: cross-sectional and lagged analyses from a 2-year observational study. Implement Sci 2018; 13:85. [PMID: 29940989 PMCID: PMC6019309 DOI: 10.1186/s13012-018-0781-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 06/18/2018] [Indexed: 11/23/2022] Open
Abstract
Background Behavioral health organizations are characterized by multiple organizational climates, including molar climate, which encompasses clinicians’ shared perceptions of how the work environment impacts their personal well-being, and strategic implementation climate, which includes clinicians’ shared perceptions of the extent to which evidence-based practice implementation is expected, supported, and rewarded by the organization. Theory suggests these climates have joint, cross-level effects on clinicians’ implementation of evidence-based practice and that these effects may be long term (i.e., up to 2 years); however, no empirical studies have tested these relationships. We hypothesize that molar climate moderates implementation climate’s concurrent and long-term relationships with clinicians’ use of evidence-based practice such that strategic implementation climate will have its most positive effects when it is accompanied by a positive molar climate. Methods Hypotheses were tested using data collected from 235 clinicians in 20 behavioral health organizations. At baseline, clinicians reported on molar climate and implementation climate. At baseline and at a 2-year follow-up, all clinicians who were present in the organizations reported on their use of cognitive-behavioral psychotherapy techniques, an evidence-based practice for youth psychiatric disorders. Two-level mixed-effects regression models tested whether baseline molar climate and implementation climate interacted in predicting clinicians’ evidence-based practice use at baseline and at 2-year follow-up. Results In organizations with more positive molar climates at baseline, higher levels of implementation climate predicted increased evidence-based practice use among clinicians who were present at baseline and among clinicians who were present in the organizations at 2-year follow-up; however, in organizations with less positive molar climates, implementation climate was not related to clinicians’ use of evidence-based practice at either time point. Conclusions Optimizing clinicians’ implementation of evidence-based practice in behavioral health requires attention to both molar climate and strategic implementation climate. Strategies that focus exclusively on implementation climate may not be effective levers for behavior change if the organization does not also engender a positive molar climate. These findings have implications for the development of implementation theory and effective implementation strategies.
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Affiliation(s)
- Nathaniel J Williams
- School of Social Work, Boise State University, 1910 University Drive, Boise, ID, 83725, USA.
| | - Mark G Ehrhart
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Steven C Marcus
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
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Multilevel Mechanisms of Implementation Strategies in Mental Health: Integrating Theory, Research, and Practice. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 43:783-798. [PMID: 26474761 DOI: 10.1007/s10488-015-0693-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A step toward the development of optimally effective, efficient, and feasible implementation strategies that increase evidence-based treatment integration in mental health services involves identification of the multilevel mechanisms through which these strategies influence implementation outcomes. This article (a) provides an orientation to, and rationale for, consideration of multilevel mediating mechanisms in implementation trials, and (b) systematically reviews randomized controlled trials that examined mediators of implementation strategies in mental health. Nine trials were located. Mediation-related methodological deficiencies were prevalent and no trials supported a hypothesized mediator. The most common reason was failure to engage the mediation target. Discussion focuses on directions to accelerate implementation strategy development in mental health.
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32
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Hamovitch E, Acri M, Bornheimer LA. Who is accessing family mental health programs? Demographic differences before and after system reform. CHILDREN AND YOUTH SERVICES REVIEW 2018; 85:239-244. [PMID: 29736093 PMCID: PMC5935464 DOI: 10.1016/j.childyouth.2017.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Childhood mental health disorders are on the rise in the United States. To ensure equitable access to care, it is important to examine the characteristics of children and families who access services. This study compares the demographic characteristics of two samples of families who participated in National Institute of Mental Health-funded studies of a Multiple Family Group model, entitled the 4Rs and 2Ss Multiple Family Group (4Rs and 2Ss) in New York City. One sample is currently receiving services, and the other received services a decade ago. Significant differences in demographic characteristics were found between the two samples pertaining to child race, child nativity, caregiver age, primary caregiver, caregiver marital status, caregiver race, caregiver education, caregiver employment, and family income. Families currently engaging in the public mental health service system are primarily White, and are less disadvantaged than families a decade ago. These differences are examined in light of changing policy and epidemiological trends, and potential unintended consequences are discussed.
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Affiliation(s)
- Emily Hamovitch
- McSilver Institute for Poverty Policy and Research, Silver School of Social Work, New York University, 41 East 11 street, 7 floor, New York NY, 10003, United States
| | - Mary Acri
- McSilver Institute for Poverty Policy and Research, Silver School of Social Work, New York University, 41 East 11 street, 7 floor, New York NY, 10003, United States
| | - Lindsay A Bornheimer
- McSilver Institute for Poverty Policy and Research, Silver School of Social Work, New York University, 41 East 11 street, 7 floor, New York NY, 10003, United States
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33
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Carson N, Progovac A, Wang Y, Cook BL. A decline in depression treatment following FDA antidepressant warnings largely explains racial/ethnic disparities in prescription fills. Depress Anxiety 2017; 34:1147-1156. [PMID: 28962069 PMCID: PMC5895183 DOI: 10.1002/da.22681] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 06/19/2017] [Accepted: 08/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Food and Drug Administration's 2004 antidepressant warning was followed by decreases in antidepressant prescribing for youth. This was due to declines in all types of depression treatment, not just the intended changes in antidepressant prescribing patterns. Little is known about how these patterns varied by race/ethnicity. METHOD Data are Medicaid claims from four U.S. states (2002-2009) for youth ages 5-17. Interrupted time series analyses measured changes due to the warning in levels and trends, by race/ethnicity, of three outcomes: antidepressant prescription fills, depression treatment visits, and incident fluoxetine prescription fills. RESULTS Prewarning, antidepressant fills were increasing across all racial/ethnic groups, fastest for White youth. Postwarning, there was an immediate drop and continued decline in the rate of fills among White youth, more than double the decline in the rate among Black and Latino youth. Prewarning, depression treatment visits were increasing for White and Latino youth. Postwarning, depression treatment stabilized among Latinos, but declined among White youth. Prewarning, incident fluoxetine fills were increasing for all groups. Postwarning, immediate increases and increasing trends of fluoxetine fills were identified for all groups. CONCLUSIONS Antidepressant prescription fills declined most postwarning for White youth, suggesting that risk information may have diffused less rapidly to prescribers or caregivers of minorities. Decreases in depression treatment visits help to explain the declines in antidepressant prescribing and were largest for White youth. An increase in incident fluoxetine fills, the only medication indicated for pediatric depression at the time, suggests that the warning may have shifted prescribing practices.
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Affiliation(s)
- Nicholas Carson
- Center for Multicultural Mental Health Research, Cambridge Health Alliance & Harvard Medical School, 1035 Cambridge Street, Suite 26, Cambridge, MA 02141, Fax: (617) 806-8740, Office: (617) 617-5269
| | - Ana Progovac
- Center for Multicultural Mental Health Research, Cambridge Health Alliance & Harvard Medical School
| | - Ye Wang
- Massachusetts General Hospital
| | - Benjamin L. Cook
- Center for Multicultural Mental Health Research, Cambridge Health Alliance & Harvard Medical School
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34
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Forman-Hoffman VL, Middleton JC, McKeeman JL, Stambaugh LF, Christian RB, Gaynes BN, Kane HL, Kahwati LC, Lohr KN, Viswanathan M. Quality improvement, implementation, and dissemination strategies to improve mental health care for children and adolescents: a systematic review. Implement Sci 2017; 12:93. [PMID: 28738821 PMCID: PMC5525230 DOI: 10.1186/s13012-017-0626-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 07/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Some outcomes for children with mental health problems remain suboptimal because of poor access to care and the failure of systems and providers to adopt established quality improvement strategies and interventions with proven effectiveness. This review had three goals: (1) assess the effectiveness of quality improvement, implementation, and dissemination strategies intended to improve the mental health care of children and adolescents; (2) examine harms associated with these strategies; and (3) determine whether effectiveness or harms differ for subgroups based on system, organizational, practitioner, or patient characteristics. METHODS Sources included MEDLINE®, the Cochrane Library, PsycINFO, and CINAHL, from database inception through February 17, 2017. Additional sources included gray literature, additional studies from reference lists, and technical experts. Two reviewers selected relevant randomized controlled trials (RCTs) and observational studies, extracted data, and assessed risk of bias. Dual analysis, synthesis, and grading of the strength of evidence for each outcome followed for studies meeting inclusion criteria. We also used qualitative comparative analysis to examine relationships between combinations of strategy components and improvements in outcomes. RESULTS We identified 18 strategies described in 19 studies. Eleven strategies significantly improved at least one measure of intermediate outcomes, final health outcomes, or resource use. Moderate strength of evidence (from one RCT) supported using provider financial incentives such as pay for performance to improve the competence with which practitioners can implement evidence-based practices (EBPs). We found inconsistent evidence involving strategies with educational meetings, materials, and outreach; programs appeared to be successful in combination with reminders or providing practitioners with newly collected clinical information. We also found low strength of evidence for no benefit for initiatives that included only educational materials or meetings (or both), or only educational materials and outreach components. Evidence was insufficient to draw conclusions on harms and moderators of interventions. CONCLUSIONS Several strategies can improve both intermediate and final health outcomes and resource use. This complex and heterogeneous body of evidence does not permit us to have a high degree of confidence about the efficacy of any one strategy because we generally found only a single study testing each strategy. TRIAL REGISTRATION PROSPERO, CRD42015024759 .
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Affiliation(s)
- Valerie L. Forman-Hoffman
- RTI International, 3040 W Cornwallis Rd, Research Triangle Park, P.O. Box 12194, Research Triangle Park, NC 27709 USA
| | - Jennifer Cook Middleton
- Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, CB# 7590 725 Martin Luther King Jr. Blvd, Chapel Hill, NC 27599-7590 USA
| | - Joni L. McKeeman
- Department of Psychiatry, UNC School of Medicine, 235 Med Sch Wing C, 7160, Chapel Hill, NC 27599 USA
| | - Leyla F. Stambaugh
- RTI International, 3040 W Cornwallis Rd, Research Triangle Park, P.O. Box 12194, Research Triangle Park, NC 27709 USA
| | - Robert B. Christian
- The Carolina Institute for Developmental Disabilities, University of North Carolina Chapel Hill, Campus Box # 7255, Chapel Hill, NC 27599-7255 USA
| | - Bradley N. Gaynes
- Department of Psychiatry, UNC School of Medicine, 304 MacNider Hall, CB #7160 333 S. Columbia Street, Chapel Hill, NC 27599 USA
| | - Heather Lynne Kane
- RTI International, 3040 W Cornwallis Rd, Research Triangle Park, P.O. Box 12194, Research Triangle Park, NC 27709 USA
| | - Leila C. Kahwati
- RTI International, 3040 W Cornwallis Rd, Research Triangle Park, P.O. Box 12194, Research Triangle Park, NC 27709 USA
| | - Kathleen N. Lohr
- RTI International, 3040 W Cornwallis Rd, Research Triangle Park, P.O. Box 12194, Research Triangle Park, NC 27709 USA
| | - Meera Viswanathan
- RTI International, 3040 W Cornwallis Rd, Research Triangle Park, P.O. Box 12194, Research Triangle Park, NC 27709 USA
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Reid G, Stewart SL, Zaric GS, Carter JR, Neufeld RWJ, Tobon JI, Barwick M, Vingilis ER. Defining Episodes of Care in Children's Mental Health Using Administrative Data. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 42:737-47. [PMID: 25403258 DOI: 10.1007/s10488-014-0609-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Criteria to define an episode of care in children's mental health services are needed. Various criteria were applied to 5 years of visit data from children 4-11 years (N = 5,206) at their first visit to 1 of 3 children's mental health agencies. A minimum of 3 visits with 180 days between episodes optimized agreement with other dates (e.g., telephone intake assessment) marking the start and end of an episode, and clinician-rated number of episodes. Grouping visits into episodes provides a clearer representation of how services are distributed over extended periods of time, facilitating research and enhancing accuracy in service planning.
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Affiliation(s)
- Graham Reid
- Department of Psychology, University of Western Ontario, London, ON, Canada. .,Department of Family Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada. .,Department of Paediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada. .,Children's Health Research Institute, London, ON, Canada. .,Lawson Health Research Institute, London, ON, Canada.
| | - Shannon L Stewart
- Faculty of Education, University of Western Ontario, London, ON, Canada.,Division of Child and Adolescent Psychiatry, Department of Psychiatry, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Gregory S Zaric
- Ivey Business School, University of Western Ontario, London, ON, Canada
| | | | - Richard W J Neufeld
- Department of Psychology, University of Western Ontario, London, ON, Canada.,Department of Psychiatry, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada.,Neuroscience Program, University of Western Ontario, London, ON, Canada
| | - Juliana I Tobon
- Department of Psychology, University of Western Ontario, London, ON, Canada.,St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Melanie Barwick
- Community Health Systems Research Group, Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychiatry and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Evelyn R Vingilis
- Department of Family Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
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Marrast L, Himmelstein DU, Woolhandler S. Racial and Ethnic Disparities in Mental Health Care for Children and Young Adults: A National Study. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2016; 46:810-24. [PMID: 27520100 DOI: 10.1177/0020731416662736] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Psychiatric and behavior problems are common among children and young adults, and many go without care or only receive treatment in carceral settings. We examined racial and ethnic disparities in children's and young adults' receipt of mental health and substance abuse care using nationally representative data from the 2006-2012 Medical Expenditure Panel Surveys. Blacks' and Hispanics' visit rates (and per capita expenditures) were about half those of non-Hispanic whites for all types and definitions of outpatient mental health services. Disparities were generally larger for young adults than for children. Black and white children had similar psychiatric inpatient and emergency department utilization rates, while Hispanic children had lower hospitalization rates. Multivariate control for mental health impairment, demographics, and insurance status did not attenuate racial/ethnic disparities in outpatient care. We conclude that psychiatric and behavioral problems among minority youth often result in school punishment or incarceration, but rarely mental health care.
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Affiliation(s)
| | - David U Himmelstein
- City University of New York at Hunter College, School of Public Health, New York, NY, USA Harvard Medical School, Boston, MA
| | - Steffie Woolhandler
- City University of New York at Hunter College, School of Public Health, New York, NY, USA Harvard Medical School, Boston, MA
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37
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Cook BL, Zuvekas SH, Chen J, Progovac A, Lincoln AK. Assessing the Individual, Neighborhood, and Policy Predictors of Disparities in Mental Health Care. Med Care Res Rev 2016; 74:404-430. [PMID: 27147641 DOI: 10.1177/1077558716646898] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study assesses individual- and area-level predictors of racial/ethnic disparities in mental health care episodes for adults with psychiatric illness. Multilevel regression models are estimated using data from the Medical Expenditure Panel Surveys linked to area-level data sets. Compared with Whites, Blacks and Latinos live in neighborhoods with higher minority density, lower average education, and greater specialist mental health provider density, all of which predict lesser mental health care initiation. Neighborhood-level variables do not have differential effects on mental health care by race/ethnicity. Racial/ethnic disparities arise because minorities are more likely to live in neighborhoods where treatment initiation is low, rather than because of a differential influence of neighborhood disadvantage on treatment initiation for minorities compared with Whites. Low rates of initiation in neighborhoods with a high density of specialists suggest that interventions to increase mental health care specialists, without a focus on treating racial/ethnic minorities, may not reduce access disparities.
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Affiliation(s)
- Benjamin L Cook
- 1 Harvard Medical School, Boston, MA, USA.,2 Cambridge Health Alliance, Cambridge, MA, USA
| | - Samuel H Zuvekas
- 3 Agency for Healthcare Research and Quality, Rockville, MD, USA
| | - Jie Chen
- 4 University of Maryland, College Park, MD, USA
| | - Ana Progovac
- 1 Harvard Medical School, Boston, MA, USA.,2 Cambridge Health Alliance, Cambridge, MA, USA
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38
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Williams NJ. Multilevel Mechanisms of Implementation Strategies in Mental Health: Integrating Theory, Research, and Practice. ADMINISTRATION AND POLICY IN MENTAL HEALTH 2015. [PMID: 26474761 DOI: 10.1007/s10488‐015‐0693‐2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
A step toward the development of optimally effective, efficient, and feasible implementation strategies that increase evidence-based treatment integration in mental health services involves identification of the multilevel mechanisms through which these strategies influence implementation outcomes. This article (a) provides an orientation to, and rationale for, consideration of multilevel mediating mechanisms in implementation trials, and (b) systematically reviews randomized controlled trials that examined mediators of implementation strategies in mental health. Nine trials were located. Mediation-related methodological deficiencies were prevalent and no trials supported a hypothesized mediator. The most common reason was failure to engage the mediation target. Discussion focuses on directions to accelerate implementation strategy development in mental health.
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Affiliation(s)
- Nathaniel J Williams
- School of Social Work, Boise State University, 1910 University Dr., Boise, ID, 83725-1940, USA.
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39
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Abstract
PURPOSE OF REVIEW There has been increased attention towards the burden imposed by mental disorders on children and adolescents. The present overview explores the current state of child and adolescent mental healthcare provision around the globe. RECENT FINDINGS Current research indicates a concerning gap in the provision of care for the child and adolescent population. The disparities between need, demand and access to youth mental healthcare are likely to be even greater in low and- middle-income countries (LAMIC), where the proportion of children and adolescents in the population is higher. The scarcity of available resources for youth mental healthcare, especially in LAMIC, represents a major obstacle to decreasing the impact of mental disorders across the lifespan. SUMMARY Our review highlights the discrepancy between demands and availability of mental healthcare for youth populations throughout the world. We describe some of the potential contributors to the current state of youth mental healthcare, such as problematic access to services, implementation deficiencies and inadequacy of policies. Recent innovative strategies to reduce these barriers are also presented.
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