Online Program

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)

Wednesday, November 4, 2015 : 9:10 a.m. - 9:30 a.m.

Danna Mauch, PhD, US Health, Abt Associates, Cambridge, MA
Deborah Allen, ScD, Boston Public Health Commission, Boston, MA
Susan G. Pfefferle, PhD, Behavioral Health, Abt Associates, Cambridge, MA
Glenn Daly, Massachusetts Executive Office of Health and Human Services, Boston, MA
Roberta Glass, MS, US Health, Abt Associates Inc., Cambridge, MA
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.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Public health or related public policy
Public health or related research

Learning Objectives:
Describe one state's approach to developing pediatric medical homes that integrate early childhood mental health. Evaluate the impact of enhanced pediatric medical homes through use of Medicaid data. Differentiate utilization and cost performance between treatment and comparison groups. Explain the challenges in conducting community based evaluation of early childhood programs in safety net pediatric medical homes. Assess the utility of Medicaid data analysis and propensity score matching methodology. Identify the significance of community partnership to conducting policy relevant research. Discuss methodological challenges and strategies, as well as outcomes of interest.

Keyword(s): Child/Adolescent Mental Health, Primary Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal or co-principal investigator or project director of multiple state and federally funded grants or contracts focusing on the prevention and treatment of mental health and/or substance use conditions in children, adolescents and adults. I have also served as a government program administrator, nonprofit provider administrator, and specialty managed care executive designing, implementing and evaluating programs targeted to populations at risk for or having behavioral health conditions and/or intellectual/developmental disabilities.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.