Use of Medicaid Data to Evaluate Effect of Integration of Early Childhood Mental Health into Pediatric Medical Homes through the Massachusetts Young Children's Interventions for Learning and Development (MYCHILD)

Background: One innovative program, MYCHILD, integrates early childhood mental health systems of care into pediatric medical homes in Boston’s safety net health clinics to promote healthy development and prevent emotional disturbance. The program targets high risk families and is instrumental in enabling families to access mental health professionals in pediatric settings and acquire treatment and supportive services.    

Methods: Program partners collaborated to acquire Medicaid data as part of the MYCHILD evaluation. Caregivers of children enrolled in MYCHILD  consented to the use of individual multiyear MassHealth data, allowing for comparisons over time. Descriptive statistics were used to identify baseline characteristics of the MassHealth population, with frequencies and cross-tabulations calculated for children in Boston compared to the rest of Massachusetts, to guide targeted dissemination of the MYCHILD model across the State. Propensity score matching was used to identify a comparison group for a quasi-experimental study to examine service utilization and cost differences between MYCHILD enrolled children and controls. Generalized linear models were used to account for the correlated nature of the data.

Findings: ED utilization for asthma exacerbations was an outcome of interest because of its association with mental illness. Additional outcomes emerged from the data, including injuries by type and mechanism, psychotropic medication use, and outpatient, inpatient and emergency department e utilization and costs.

Implications: Evidence suggests that enhanced pediatric medical homes can reduce access disparities and provide early intervention for emergent social, emotional and behavioral problems that impact healthy development. Policymakers require services utilization, cost and outcome data to inform replication and sustain innovations.