Public Health Coverage and Access to Mental Health Care for Youth with Complex Behavioral Healthcare Needs
- 44 Downloads
Drawing upon the National Survey of Children with Special Healthcare Needs (2009/2010), multilevel logistic regression analysis assessed the relationship between parent report of a youth having an emotional, behavioral, or developmental problem (EBDP), their level of reported functional limitations, and parents’ report of unmet mental health care needs and experience with cost-barriers to accessing needed healthcare services. Results indicate that, compared to all privately insured youth with special health care needs, parents of privately insured youth with EBDP are much more likely to report their child having unmet mental health care needs (OR 12.16; p < 0.001) and experiencing cost barriers to care (OR 2.37; p < 0.001). Parents of privately insured youth with EBDP with functional limitations are even more likely to report these concerns (Unmet Mental Health Needs: OR 17.09; p < 0.001; Cost Barriers: OR 5.77; p < 0.001). However, findings suggest that having public insurance is associated with reductions in the odds of having unmet needs for youth with SED by 50%. Public insurance and dual coverage is associated with reductions in the odds of encountering cost barriers to care by almost 50% for children with EBDP, and by more 50% for youth with EBDP and functional impairments.
KeywordsSerious emotional disturbance Medicaid Health insurance Mental health access Children’s mental health
This study was not funded.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
- Barth, R., Greenson, J., Guo, S., Green, R., & Sisson, J. (2007). Outcomes for youth receiving intensive in-home therapy or residential care: A comparison using propensity scores. American Journal of Orthopsychiatry,77(4), 497–505. https://doi.org/10.1037/0002-94184.108.40.2067.CrossRefPubMedGoogle Scholar
- Beckles, G. L. A., Williamson, D. F., Brown, A. F., Gregg, E. W., Karter, A. J., Kim, C., et al. (2007). Agreement between self-reports and medical records was only fair in a cross-sectional study of performance of annual eye examinations among adults with diabetes in managed care. Medical Care,45(9), 876–883. https://doi.org/10.1097/MLR.0b013e3180ca95fa.CrossRefPubMedGoogle Scholar
- Blackman, J. A., Gurka, M. J., Gurka, K. K., & Oliver, M. N. (2011). Emotional, developmental and behavioural co-morbidities of children with chronic health conditions. Journal of Paediatrics and Child Health,47(10), 742–747. https://doi.org/10.1111/j.1440-1754.2011.02044.x.CrossRefPubMedGoogle Scholar
- Bramlett, M. D., Read, D., Bethell, C., & Blumberg, S. J. (2009). Differentiating subgroups of children with special health care needs by health status and complexity of health care needs. Maternal and Child Health Journal,13(2), 151–163. https://doi.org/10.1007/s10995-008-0339-z.CrossRefPubMedGoogle Scholar
- Chavira, D. A., Garland, A. F., Daley, S., & Hough, R. (2008). The impact of medical comorbidity on mental health and functional health outcomes among children with anxiety disorders. Journal of Developmental and Behavioral Pediatrics: JDBP,29(5), 394–402. https://doi.org/10.1097/DBP.0b013e3181836a5b.CrossRefPubMedGoogle Scholar
- Cook, B. L., Doksum, T., Chen, C.-N., Carle, A., & Alegría, M. (2013). The role of provider supply and organization in reducing racial/ethnic disparities in mental health care in the U.S. Social Science and Medicine, 84, 102–109. https://doi.org/10.1016/j.socscimed.2013.02.006.CrossRefPubMedGoogle Scholar
- Costello, E. J., He, J., Sampson, N. A., Kessler, R. C., & Merikangas, K. R. (2014). Services for adolescents with psychiatric disorders: 12-month data from the National Comorbidity Survey-Adolescent. Psychiatric Services (Washington, D.C.),65(3), 359–366. https://doi.org/10.1176/appi.ps.201100518.CrossRefGoogle Scholar
- Friedman, S. L., Norwood, K. W., & Disabilities, C. on C. W. (2016). Out-of-home placement for children and adolescents with disabilities—addendum: Care options for children and adolescents with disabilities and medical complexity. Pediatrics,138(6), e20163216. https://doi.org/10.1542/peds.2016-3216.CrossRefPubMedGoogle Scholar
- Graaf, G., & Snowden, L. (2019). State approaches to funding home and community-based mental health care for non-Medicaid youth: Alternatives to Medicaid waivers. Administration and Policy in Mental Health and Mental Health Services Research. https://doi.org/10.1007/s10488-019-00933-2.CrossRefPubMedGoogle Scholar
- Greenbaum, P. E., Dedrick, R. F., Friedman, R. M., Kutash, K., Brown, E. C., Lardieri, S. P., et al. (1996). National Adolescent and Child Treatment Study (NACTS): Outcomes for children with serious emotional and behavioral disturbance. Journal of Emotional and Behavioral Disorders,4(3), 130–146. https://doi.org/10.1177/106342669600400301.CrossRefGoogle Scholar
- Holgash, K., & Heberlein, M. (2019). Physician acceptance of new medicaid patients: What matters and what doesn’t| health affairs. Retrieved August 21, 2019, from https://www.healthaffairs.org/do/10.1377/hblog20190401.678690/full/#.XVwyNWJg5ZM.email.
- Howell, E. M. (2004). Access to Children’s Mental Health Services under Medicaid and SCHIP. Retrieved from The Urban Institute from http://webarchive.urban.org/publications/311053.html.
- Kernan, J. B., Griswold, K. S., & Wagner, C. M. (2003). Seriously emotionally disturbed youth: A needs assessment. Community Mental Health Journal,39(6), 475–486. https://doi.org/10.1023/B:COMH.0000003009.21130.da.CrossRefPubMedGoogle Scholar
- Kessler, R. C., Avenevoli, S., Costello, J., Green, J. G., Gruber, M. J., McLaughlin, K. A., et al. (2012). Severity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication Adolescent Supplement. Archives of General Psychiatry,69(4), 381–389. https://doi.org/10.1001/archgenpsychiatry.2011.1603.CrossRefPubMedPubMedCentralGoogle Scholar
- Nageswaran, S., Parish, S. L., Rose, R. A., & Grady, M. D. (2011). Do children with developmental disabilities and mental health conditions have greater difficulty using health services than children with physical disorders? Maternal and Child Health Journal,15(5), 634–641. https://doi.org/10.1007/s10995-010-0597-4.CrossRefPubMedGoogle Scholar
- Owens, P., Hoagwood, K., Horwitz, S. M., Leaf, P. J., Poduska, J., Kellam, S. G., et al. (2002). Barriers to children’s mental health services. Journal of the American Academy of Child and Adolescent Psychiatry,41(6), 731–738. https://doi.org/10.1097/00004583-200206000-00013.CrossRefPubMedGoogle Scholar
- Palmer, L., Johnston, S. S., Rousculp, M. D., Chu, B.-C., Nichol, K. L., & Mahadevia, P. J. (2012). Agreement between Internet-based self- and proxy-reported health care resource utilization and administrative health care claims. Value in Health: The Journal of the International Society for Pharmacoeconomics and Outcomes Research,15(3), 458–465. https://doi.org/10.1016/j.jval.2011.12.015.CrossRefGoogle Scholar
- Pires, S. A., Grimes, K. E., Allen, Gilmer, T., & Mahadevan, R. (2013). Faces of Medicaid: Examining Children’s Behavioral Health Service Use and Expenditures. Retrieved from Center for Health Care Strategies http://www.chcs.org/.
- Short, M. E., Goetzel, R. Z., Pei, X., Tabrizi, M. J., Ozminkowski, R. J., Gibson, T. B., et al. (2009). How accurate are self-reports? An analysis of self-reported healthcare utilization and absence when compared to administrative data. Journal of Occupational and Environmental Medicine/American College of Occupational and Environmental Medicine,51(7), 786–796. https://doi.org/10.1097/JOM.0b013e3181a86671.CrossRefPubMedCentralGoogle Scholar
- Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: Prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child and Adolescent Psychiatry,47(8), 921–929. https://doi.org/10.1097/CHI.0b013e318179964f.CrossRefPubMedPubMedCentralGoogle Scholar
- Snowden, L. R., Masland, M., Wallace, N., Fawley-King, K., & Cuellar, A. E. (2008). Increasing California children’s Medicaid-financed mental health treatment by vigorously implementing Medicaid’s Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Program. Medical Care, 46(6), 558–564. https://doi.org/10.1097/MLR.0b013e3181648e82.CrossRefPubMedGoogle Scholar
- Stiffman, A. R., Hadley-Ives, E., Doré, P., Polgar, M., Horvath, V. E., Striley, C., et al. (2000). Youths’ access to mental health services: The role of providers’ training, resource connectivity, and assessment of need. Mental Health Services Research,2(3), 141–154. https://doi.org/10.1023/A:1010189710028.CrossRefPubMedGoogle Scholar
- Stroul, B. A. (1993). Systems of care for children and adolescents with severe emotional disturbances: What are the results? Retrieved from http://eric.ed.gov/?id=ED364025.
- Substance Abuse and Mental Health Services Administration, & Center for Mental Health Services. Definition of children with a serious emotional disturbance., Pub. L. No. 29425, 96 58 (1993).Google Scholar
- Thomas, K. C., Williams, C. S., deJong, N., & Morrissey, J. P. (2016). Examination of parent insurance ratings, child expenditures, and financial burden among children with autism: A mismatch suggests new hypotheses to test. Pediatrics,137(Supplement 2), S186–S195. https://doi.org/10.1542/peds.2015-2851Q.CrossRefPubMedGoogle Scholar
- Urdapilleta, O., Kim, G., Wang, Y., Howard, J., Varghese, R., Waterman, G., … Palmisano, C. (2013). National evaluation of the medicaid demonstration waiver home- and community-based alternatives to psychiatric residential treatment facilities. Retrieved from Submitted to Disabled and Elderly Health Programs Group Centers for Medicare and Medicaid Services, Contract Number: HHSM-500-2006-00007I, Task Order #2 Final Evaluation Report. IMPAQ Interntional, Inc http://www.bazelon.org/News-Publications/Publications/List/1/CategoryID/20/Level/a.aspx?SortField=ProductNumber%2cProductNumber.
- Varda, D. M., Hardy, R., & Talmi A. M. and A. (2016). Public health, mental health and primary care differences in urban and rural counties in a system of care for children with special healthcare needs. Health Systems and Policy Research. Retrieved from http://www.hsprj.com/abstract/public-health-mental-health-and-primaryrncare-differences-in-urban-and-rural-countiesrnin-a-system-of-care-for-children-with-specialrnhealthcare-needs-11194.html