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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Susan dosReis, PhD1, Pamela Owens, PhD2, David Michalik3, Paula Hibbert3, Nancy Widdoes4, and Philip Leaf, PhD5. (1) Division of Child and Adolescent Psychiatry, Johns Hopkins Medical Institutions, 600 N. Wolfe Street, CMSC 346, Baltimore, MD 21287, 443-287-4347, sdosrei1@jhmi.edu, (2) Bloomberg School of Public Health, Johns Hopkins University, Department of Mental Hygiene, 624 N. Wolfe Street, Baltimore, MD 21287, (3) Division of Social Services, State Medicaid Administration, (4) Division of Child Mental Health Services, Department of Services for Children, Youth and Their Families, (5) Hopkins Center for the Prevention of Youth Violence, Johns Hopkins School of Public Health, 624 North Broadway, Baltimore, MD 21205
Study Objectives: The Surgeon General’s report on children’s mental health emphasized the need to eliminate health disparities in service use, yet there is limited knowledge of community-based patterns of children’s mental health services and psychotropic medication use. This study was undertaken to examine differences in the use of mental health services for attention-deficit/hyperactivity disorder (ADHD) and depression in a youth Medicaid population.
Methods: The population included all children <20 years old who were enrolled in a Mid-Atlantic state’s Medicaid and Children's Health Insurance (SCHIP) Programs in 1998 (n=58,458) and 1999 (n=67,691). Using administrative fee-for-service claims and managed care encounter databases, eligibility files as well as healthcare and pharmacy services in 1998 and 1999 were examined. Claims/encounters associated with mental disorders (ICD-9: 290-319), a mental health procedure codes, or psychotropic medications were identified. Mental health services were defined as a visit for a psychotherapy session, psychotropic management, or a mental health assessment. Using a cross-sectional design, the prevalence of ADHD and depression was established, and the use of mental health services was compared in relation to age, gender, race/ethnicity, and Medicaid eligibility category (disabled, foster care, and temporary assistance to needy families [TANF]).
Results: Approximately 17% of the population had a visit related to a mental health procedure, diagnosis, or psychotropic medication. The prevalence of ADHD visits ranged from 3.3-3.6, of which 47% involved a mental health service. The proportion of youths with an ADHD visit who also received a psychotropic medication, the majority of which were stimulants, was 84%. The prevalence of any visit for depression was 1%, of which 75% involved a mental health service. The proportion of youths with an ADHD visit who also received a psychotropic medication, primarily antidepressants, was 68%. The use of mental health services was higher among males, children 10 years or older, disabled youths, and youths in foster care. By comparison, the use of mental health services was lower among children eligible under TANF and of Hispanic ethnicity. Among visits where a mental health service was provided, the use of antidepressants, mood-stabilizers, and antipsychotics was higher, whereas stimulant use was higher among visits that did not involve a mental health service.
Conclusion: There are apparent differences in the use of mental health treatments with respect to age, gender, race/ethnicity and Medicaid eligibility category. Additional research is needed to fully understand the factors influencing the use of mental health services.
Learning Objectives: At the conclusion of this session, the participant will be able to
Keywords: Child/Adolescent Mental Health, Mental Health Services
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.