This study describes the rate that Medicaid encounter data on gender, race/ethnicity, and diagnosis matched information in the medical record, among a statewide sample of Medicaid children who received ongoing care for attention deficit hyperactivity disorder (ADHD), conduct disorder (CD), and major depression (MD) in outpatient specialty mental health clinics in 1998–1999. The match rate for gender was 99%; and for race/ethnicity it was 71.8%, 90.5%, and 89.7% for Caucasian, African American, and Hispanic children, respectively. Misidentified Caucasian children were more likely to be recorded as African American or Hispanic than misidentified minority children to be recorded as Caucasian. Diagnosis match rates were high (ADHD: 98%, CD: 89%, MD: 89%). If the California Department of Mental Health relied solely on Medicaid encounter data, misclassification of African American or Hispanic children as Caucasian could produce an underestimate of their service use.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Radigan M, Lannon P, Roohan P, et al. Psychotropic medication patterns for attention deficit hyperactivity disorder and comorbid psychiatric conditions in a low income population. Journal of Child and Adolescent Psychopharmacology. 2005;15:44–56.
dosReis S, Owens PL, Puccia KB, et al. Multimodal treatment for ADHD among youths in three Medicaid subgroups: disabled, foster care, and low income. Psychiatric Services. 2004;55:1041–1048.
Martin A, Van Hoof T, Stubbe D, et al. Multiple psychotropic pharmacotherapy and child and adolescent enrollees in Connecticut Medicaid managed care. Psychiatric Services. 2003;54:72–77.
Mandell DS, Listerud J, Levy SE, et al. Race differences in the age at diagnosis among Medicaid-eligible children with autism. Journal of the American Academy of Child and Adolescent Psychiatry. 2002;41:1447–1453.
Shireman TI, Olson BM, Dewan NA. Patterns of antidepressant use among children and adolescents. Psychiatric Services. 2002:53:1444–1450.
Zito JM, Safer DJ, Zuckerman IH, et al. Effect of Medicaid eligibility category on racial disparities in the use of psychotropic medications among youths. Psychiatric Services. 2005;56:157–163.
Zito JM, Safer DJ, dosReis S, et al. Psychotropic practice patterns for youth: a 10-year perspective. Archives Pediatric Adolescent Medicine. 2003;157:17–25.
Zito MJ, Safer DJ, dosReis S, et al. Racial disparity in psychotropic medications prescribed for youths with Medicaid insurance in Maryland. Journal of the American Academy of Child and Adolescent Psychiatry. 1998;37:179–184.
Bright RA, Avorn J, Everitt DE. Medicaid data as a resource for epidemiologic studies: strengths and limitations. Journal of Clinical Epidemiology. 1989;42:937–945.
Hennessy S, Bilker WB, Weber A, et al. Descriptive analyses of the integrity of a US Medicaid claims database. Pharmacoepidemiology and Drug Safety. 2003;12:103–111.
Carson JL, Ray WA, Strom BL. Medicaid Databases. In: Strom BL, ed. Pharmacoepidemiology (3rd Ed.). Chichester, West Sussex, England: Wiley; 2000:307–324.
Lessler JT, Harris BSH. Medicaid as a Source for Postmarketing Surveillance Information, Final Report. Volume I: Technical Report. Research Triangle Park, NC: Research Triangle Institute; 1984.
Foster EM, Connor T. Public costs of better mental health services for children and adolescents. Psychiatric Services. 2005;56:50–55.
Burns BJ, Phillips SD, Wagner HR, et al. Mental health need and access to mental health services by youths involved with child welfare: a national survey. Journal of the American Academy of Child and Adolescent Psychiatry. 2004;43:960–970.
Farmer EMZ, Burns BJ, Phillips SD, et al. Pathways into and through mental health services for children and adolescents. Psychiatric Services. 2003;54:60–66.
Bussing R, Zima BT, Gary FA, et al. Barriers to detection, help-seeking, and service use for children with ADHD symptoms. The Journal of Behavioral Health Services & Research. 2003;30:176–189.
Bussing R, Zima BT, Perwien AR, et al. Children in special education programs: attention deficit hyperactivity disorder, use of services, and unmet needs. American Journal of Public Health. 1998;88:880–886.
Hough RL, Hazen AL, Soriano FI, et al. Mental health services for Latino adolescents with psychiatric disorders. Psychiatric Services. 2002;53:1556–1562.
Angold A, Erkanli A, Farmer EMZ, et al. Psychiatric disorder, impairment, and service use in rural African American and White youth. Archives of General Psychiatry. 2002;59:893–901.
Zima BT, Bussing R, Yang X, et al. Help-seeking steps and service use among children in foster care. Journal of Behavioral Health Services & Research. 2000:27;271–285.
Cuffe SP, Waller JL, Cuccaro ML, et al. Race and gender differences in the treatment of psychiatric disorders in young adolescents. Journal of the American Academy of Child and Adolescent Psychiatry. 1995;34:1536–1543.
Zwaanswijk M, Van der Ende J, Verhaak PTM, et al. Factors associated with adolescent mental health service need and utilization. Journal of the American Academy of Child and Adolescent Psychiatry. 2003;42:692–700.
Zahner GEP, Pawelkiewicz W, DeFrancesco JJ, et al. Children's mental health service needs and utilization patterns in an urban community: an epidemiological assessment. Journal of the American Academy of Child and Adolescent Psychiatry. 1992;31:951–960.
Office of the Surgeon General, Department of Health and Human Services. Report of the Surgeon General's Conference on Children's Mental Health: A National Action Agenda. Rockville, MD: National Institute of Mental Health, Office of Communications and Public Liaison; 2001. Also available at www.surgeongeneral.gov/cmh/. Accessed March 9, 2005.
Institute of Medicine Committee on Quality Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001.
President's New Freedom Commission on Mental Health. Achieving the Promise: Transforming Mental Health Care in America. 2003. Available at http://www.mentalhealthcommission.gov/reports/FinalReport/FullReport.htm. Accessed March 9, 2005.
Richardson LP, DiGiuseppe D, Garrison M, et al. Depression in Medicaid-covered youth: differences by race and ethnicity. Archives of Pediatric and Adolescent Medicine. 2003;157:984–989.
Zima BT, Hurlburt M, Knapp P, et al. Quality of publicly-funded outpatient specialty mental health care for common childhood psychiatric disorders in California. Journal of the American Academy of Child and Adolescent Psychiatry. 2005;44:130–144.
Dickey B, Hermann RC, Eisen SV. Assessing the quality of psychiatric care: research methods and application in clinical practice. Harvard Review of Psychiatry. 1998;6:88–96.
Lurie N, Popkin M, Dysken M, et al. Accuracy of diagnoses of schizophrenia in Medicaid claims. Hospital and Community Psychiatry. 1992;43:69–71.
Walkup JT, Boyer CA, Kellermann SL. Reliability of Medicaid claims files for use in psychiatric diagnoses and service delivery. Administration and Policy in Mental Health. 2000;27:129–139.
Steinwachs DM, Stuart ME, Scholle S, et al. A comparison of ambulatory Medicaid claims to medical records: a reliability assessment. American Journal of Medical Quality. 1998;13:63–69.
Twiggs JE, Fifield J, Apter AJ, et al. Stratifying medical and pharmaceutical administrative claims as a method to identify pediatric asthma patients in a Medicaid managed care organization. Journal of Clinical Epidemiology. 2002;55:938–944.
Hodges K, Wong M, Latessa M. Use of the Child and Adolescent Functional Assessment Scale (CAFAS) as an outcome measure in clinical settings. The Journal of Behavioral Health Services Research. 1998;25:325–336.
Renouf AG, Kovacs M. Concordance between mothers' reports and children's self-reports of depressive symptoms: a longitudinal study. Journal of the American Academy of Child and Adolescent Psychiatry. 1994;33:208–216.
Luby JL, Heffelfinger AK, Mrakotsky C, et al. Preschool major depressive disorder: preliminary validation for developmentally modified DSM-IV criteria. Journal of the American Academy of Child and Adolescent Psychiatry. 2002;41:928–937.
Williamson DE, Birmaher B, Brent DA, et al. Atypical symptoms of depression in a sample of depressed child and adolescent outpatients. Journal of the American Academy of Child and Adolescent Psychiatry. 2000;39:1253–1259.
Fabrega H, Ulrich R, Mezzich JE. Do Caucasian and Black adolescents differ at psychiatric intake? Journal of the American Academy of Child and Adolescent Psychiatry. 1993;32:407–413.
McMiller WP, Weisz JR. Help-seeking preceding mental health clinic intake among African American, Latino, and Caucasian youths. Journal of the American Academy of Child and Adolescent Psychiatry. 1996;35:1086–1094.
Kataoka SH, Zhang L, Wells KB. Unmet need for mental health care among U.S. children: variation by ethnicity and insurance status. American Journal of Psychiatry. 2002;159:1548–1555.
Alegria M, Canino G, Rios R, et al. Inequalities in use of specialty mental health services among Latinos, African Americans, and non-Latino Whites. Psychiatric Services. 2002;53:1547–1555.
Rushton JL, Whitmire T. Pediatric stimulant and selective serotonin reuptake inhibitor prescription trends. Archives of Pediatrics & Adolescent Medicine. 2001;155:560–565.
Aronen ET, Noam GG, Weinstein SR. Structured diagnostic interviews and clinicians' discharge diagnosis in hospitalized adolescents. Journal of the American Academy of Child and Adolescent Psychiatry. 1993;32:674–681.
Lewczyk CM, Garland AF, Hurlburt MS, et al. Comparing DISC-IV and clinician diagnoses among youths receiving public mental health services. Journal of the American Academy of Child and Adolescent Psychiatry. 2003;42:349–356.
Piacentini J, Shaffer D, Fisher P, et al. The diagnostic interview schedule for children-revised version (DISC-R): III. Concurrent criterion validity. Journal of the American Academy of Child and Adolescent Psychiatry. 1993;32:658–665.
Wells KB, Sherbourne C, Schoenbaum M, et al. Impact of disseminating quality improvement programs for depression in managed primary care: a randomized controlled trial. Journal of the American Medical Association. 2000;283:212–220.
McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. New England Journal of Medicine. 2003;348:2635–2645.
Young AS, Klap R, Sherbourne CD, et al. The quality of care for depressive and anxiety disorders in the United States. Archives of General Psychiatry. 2001;58:55–61.
This study was supported by the State of California Department of Mental Health and the National Institute of Mental Health (P30 MH68639, P50 MH546230, P50 MH50313). The authors gratefully acknowledge Dr. Stephen Mayberg, Director of the State of California Department of Mental Health, for his outstanding leadership, and the California Mental Health Directors Association and California Mental Health Planning Council for their cooperation that made this study possible. The information contained in this report reflects the author's views, and not necessarily the views or position of the Department of Mental Health.
Michael S. Hurlburt, PhD, is a research scientist at Child and Adolescent Services Research Center, Children's Hospital, San Diego, 3020 Children's Way, San Diego, CA 92123-0282, USA.
Eric C. Kostello, PhD, is a research sociologist at University of California at Los Angeles, Health Services Research Center, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA 90024-6505, USA.
Heather Ladd, MS, is a data analyst at University of California at Los Angeles, Health Services Research Center, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA 90024-6505, USA.
Lingqi Tang, PhD, is a statistician at University of California at Los Angeles, Health Services Research Center, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA 90024-6505, USA.
Bonnie T. Zima, MD, MPH, is a professor-in-residence of the Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Health Services Research Center, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA 90024-6505, USA.
About this article
Cite this article
Knapp, P.K., Hurlburt, M.S., Kostello, E.C. et al. Child Sociodemographic Characteristics and Common Psychiatric Diagnoses in Medicaid Encounter Data: Are they Valid?. J Behav Health Serv Res 33, 444–452 (2006). https://doi.org/10.1007/s11414-006-9024-4
- Attention Deficit Hyperactivity Disorder
- Major Depression
- Conduct Disorder
- Attention Deficit Hyperactivity Disorder
- Claim Data