Mental Health Service Use by Medicaid-Enrolled Children and Adolescents in Primary Care Safety-Net Clinics

• Type of Material: Article
• Authors: Janet Cummings, Emory University; Xu Ji, Emory University; Benjamin Druss, Emory University
• Language: English
• Date: 2020-04-01
• Publisher: American Psychiatric Publishing, Inc.
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020 American Psychiatric Association.
• Final Published Version (URL): http://dx.doi.org/10.1176/appi.ps.201800540
• Title of Journal or Parent Work: Psychiatric Services
• Volume: 71
• Issue: 4
• Start Page: 328
• End Page: 336
• Grant/Funding Information: This work was supported by the National Institute of Mental Health (K01MH095823).
• Keywords: Public, Environmental & Occupational Health; Science & Technology; Centers; Psychiatry; Access; Life Sciences & Biomedicine; Health Care Sciences & Services; Prevalence; Disorders; Depression; Health Policy & Services
• Research Categories: Health Sciences, Health Care Management; Health Sciences, Mental Health; Psychology, Clinical

Abstract

OBJECTIVE: Little is known about the role of primary care safety-net clinics, including federally qualified health centers and rural health clinics, in providing mental health services to youth. This study examines correlates and quality of care of mental health care for youth treated in these safety-net settings. METHODS: We used Medicaid claims data (2008–2010) from nine states to identify youth initiating ADHD medication (N=6,433) and youth with an incident depression diagnosis (N=13,209). We identified those that received: (1) no ADHD or depression-related visits from a primary care safety-net clinic (reference); (2) some (but less than most) visits from these clinics; (3) most visits from these clinics. We examined correlates of mental health treatment in these settings, and whether mental health visits in these settings were correlated with quality measures using bivariate and regression analyses. RESULTS: Only 13.5% of youth initiating ADHD medication and 7.2% of youth with an index depression diagnosis sought any treatment in primary care safety-net clinic. Those living in more urbanized counties were less likely to receive mental health treatment in a primary care safety-net clinic (p<0.01). Those who received the majority of mental health treatment in a primary care safety-net clinic (versus no mental health treatment in these settings) had lower care quality on five of six measures (p<0.01). CONCLUSION: As investment in the expansion of mental health services in primary care safety-net clinics continues to grow, future research should assess whether these resources translate into improved mental health care access and quality for Medicaid-enrolled youth.