Patterns of Child Mental Health Service Delivery in a Public System: Rural Children and the Role of Rural Residence
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This study uses existing data from Hawaii’s public mental health system for children and youth as an example of a state-level examination of service use patterns and health care disparities. The purpose of this study was to compare differences in mental health service utilization between rural and non-rural children, especially use of residential services. This study used a performance measure approach to conduct multi-level modeling on existing administrative data to examine the impact of community factors on service utilization. Rural children were found to have the most serious levels of mental health problems at intake, more likely to be placed in out-of-home care, more likely to receive only out-of-home care, more likely to in stay out-of-home longer, and less likely to receive follow-up care than their non-rural counterparts. Practice, policy, and research implications are discussed.
KeywordsMental Health Service Mental Health System Rural Child Mental Health Service Utilization Public Mental Health System
The authors thank Robert Saunders, Ph.D., for his early work on the dataset. At the time the data for this study were pulled, Dr. Higa-McMillan was working for the Hawaii Department of Health, and Dr. Brannan was affiliated with Vanderbilt University. This research was supported by a grant from the National Institute of Mental Health (R01MH70680). The opinions contained in this document are those of the authors and do not necessarily reflect those of the funding source or the Hawaii Department of Health.
Conflict of Interest
There are no conflicts of interest or disclosures.
- 1.Stroul BA, Friedman RM. A System of Care for Severely Emotionally Disturbed Children and Youth. Washington, DC: Georgetown University Child Development Center, CASSP Technical Assistance Center, 1986.Google Scholar
- 2.Stroul BA, Blau G, Friedman RM. Updating the System of Care Concept and Philosophy. Washington, DC: Georgetown University Center for Child and Human Development, National Technical Assistance Center for Children’s Mental Health, 2010.Google Scholar
- 3.Hawaii Department of Health. Child and Adolescent Mental Health Performance Standards, State of Hawaii. Honolulu, HI: Author, 2012.Google Scholar
- 4.Substance Abuse and Mental Health Services Administration (SAMHSA). The Comprehensive Community Mental Health Services for Children and Their Families Program, Evaluation Report: Annual report to Congress 2010. Rockville, MD: Author, 2012.Google Scholar
- 5.National Committee on Quality Assurance (NCQA). The Healthcare Effectiveness Data and Information Set (HEDIS). Washington, DC: Author, n.d.Google Scholar
- 6.Dougherty Management Associates. Children’s Mental Health Benchmarking Project: Year 4. Lexington, MA: Author, 2005.Google Scholar
- 7.Perlman SB, Nechasek SL, Dougerty RH. Children’s Mental Health Benchmarking: Progress and potential. Behavioral Healthcare Tomorrow 1999; 10(14):36–37.Google Scholar
- 11.Substance Abuse and Mental Health Services Administration (SAMHSA). Mental Health Statistics Improvement Program: Consumer-oriented mental health report card. Rockville, MD: SAMHSA Center for Mental Health Services, 1996.Google Scholar
- 12.Scholle SH, Sampsel SL, Davis NE, et al. Quality of Child Health Care: Expanding the Scope and Flexibility of Measurement Approaches. Washington, DC: National Committee on Quality Assurance, 2009.Google Scholar
- 21.United States Census Bureau. United States Census 2000. Available online at www.census.gov. Accessed April 28, 2014.
- 23.Chorpita BF, Donkervoet CM. Implementation of the Felix Consent Decree in Hawaii: The impact of policy and practice development efforts on service delivery. In: RG Steele, MC Roberts (Eds.), Handbook of Mental Health Services for Children, Adolescents, and Families. New York: Kluwer, 2005, pp. 317–332.CrossRefGoogle Scholar
- 27.Simonelli SH. School based behavioral health review: Creating a context. Effective Practices Brief. Center of Disability Studies, University of Hawai'i at Manoa, 2001.Google Scholar
- 28.National Center for Education Statistics (NCES). Census 2000 School District Tabulation (STP2). Washington, DC, n.d.Google Scholar
- 29.Accountability Resource Center Hawaii (ARCH). Trend report: Educational and Fiscal Accountability. Trend Reports 2007. Google Scholar
- 30.Hawaii Department of Education. Felix' integrated performance monitoring reports. Honolulu, HI: Author, 2007.Google Scholar
- 32.WWAMI Rural Health Research Center. Rural Urban Commuting Codes (Version 2.0). Seattle, WA: University of Washington, 2006.Google Scholar
- 33.Washington State Department of Health. Guidelines for using rural–urban classification systems for public health assessment. Tumwater, WA, 2006.Google Scholar
- 34.Raudenbush SW, Bryk AS, Congdon R. HLM 6 for Windows [Computer software]. Skokie, IL: Scientific Software International, Inc., 2004.Google Scholar
- 35.Raudenbush S, Bryk A, Cheong YF, et al. HLM 6: Linear and nonlinear modeling. Lincolnwood, IL: Scientific Software International, Inc., 2004.Google Scholar
- 37.Levey NN. Hawaii’s trailblazing healthcare underscores disparity. LA Times 2014, April 4. Available online at latimes.com/nation/la-na-healthcare-coverage-20140406-m,0,6814666.story. Accessed April 28, 2014.Google Scholar
- 38.Rosas SR, Behar LB, Hydaker WM. Community readiness within systems of care. Journal of Behavioral Health Services and Research (published online, 2014). Available online at http://link.springer.com/article/ 10.1007/s11414-014-9401-3 . Accessed April 28, 2014.
- 41.Mueller C, Orimoto L. Factors related to the recruitment, training and retention of family day care providers. Child Welfare 1995; 74:1205–1221.Google Scholar