Predictors of aftercare services for youth with substance use and mental health disorders

This study seeks to understand factors affecting receipt of aftercare services for youth discharged from an inpatient hospitalization related to a mental health or substance abuse disorder. Data come from the Tennessee Medicaid claims for services that occurred between July 1, 1996 and December 31, 2003. The data contain 25,668 inpatient stays from 15,071 patients and 234 number of billing codes (reimbursed entity). The data were arranged in person-week format resulting in 83,386 records. A multilevel discrete-time hazard model was used to model receipt of aftercare services as a function of mental health diagnosis (physical health-related, serious mental illness, depression, conduct disorder, anxiety, attention deficit and or hyperactivity, developmental disability, alcohol-related, drug-related), gender, race, age, eligibility category for Medicaid (social security income, medically needy, foster care, cash assistance, poverty, other state, uninsured) and year. Only forty-four percent of patients discharged from the hospital received outpatient services within one week following treatment. Within thirty days post-discharge, 59% of the sample received outpatient care and 8% were readmitted. Time-until follow-up was shorter for patients with serious mental illness, depression, anxiety, or a general health ailment than those without. Similarly, follow-up time was shorter for females than males. Treatment engagement is typically measured as having two outpatient visits following an inpatient stay. Yet, 40% of the sample of youth and young adults had not even had one outpatient visit. Further, research to examine ways to improve outpatient visit rates among this population will be discussed.