Abstract
Poorly-managed early childhood disruptive behavior disorders (DBDs) have costly psychological and societal burdens. While parent management training (PMT) is recommended to effectively manage DBDs, appointment adherence is poor. Past studies on influential factors of PMT appointment adherence focused on parental factors. Less well studied are social drivers relative to early treatment gains. This study investigated how financial and time cost relative to early gains influence PMT appointment adherence for early childhood DBDs in a clinic of a large behavioral health pediatric hospital from 2016 to 2018. Using information obtained from the clinic’s data repository, claims records, public census and geospatial data, we assessed how owed unpaid charges, travel distance from home to clinic, and initial behavioral progress influences total and consistent attendance of appointments for commercially- and publicly-insured (Medicaid and Tricare) patients, controlling for demographic, service, and clinical differences. We further assessed how social deprivation interacted with unpaid charges to influence appointment adherence for commercially-insured patients. Commercially-insured patients had poorer appointment adherence with longer travel distances, or having unpaid charges and greater social deprivation; they also attended fewer total appointments with faster behavioral progress. Comparatively, publicly-insured patients were not affected by travel distance and had higher consistent attendance with faster behavioral progress. Longer travel distance and difficulty paying service costs while living in greater social deprivation are barriers to care for commercially-insured patients. Targeted intervention may be needed for this specific subgroup to attend and stay engaged in treatment.
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Acknowledgements
We thank the clinicians and clinical leadership at the outpatient behavioral therapy clinic at the Kennedy Krieger Institute for their commitment to treatment quality and participating as key informants in this study. We acknowledge the foundational efforts of the Director of the Department of Behavioral Psychology, Dr. Michael Cataldo, PhD., who supported and initially guided the investments to create the treatment accountability infrastructure within the outpatient behavioral psychology clinics. We also thank faculty from the Bloomberg School of Public Health who provided guidance in the development of this study.
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This research was supported by the Kennedy Krieger Institute’s Department of Behavioral Psychology as an aspect of the Department’s outpatient treatment accountability and improvement practice.
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All authors contributed to the study conception and design. Study selection and data extraction was initially performed by Helen Yu-Lefler. Yea-Jen Hsu, Aditi Sen, and Jill Marsteller provided subject matter expertise on variable selection and refinement, data analysis, and results interpretation. The first draft of the manuscript was written by Helen Yu-Lefler and all authors contributed to subsequent versions of the manuscript, and read and approved the final manuscript.
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Yu-Lefler, H.F., Hsu, YJ., Sen, A. et al. Service Utilization for Parent Management of Early Childhood Behavior Problems in a Private Outpatient Behavioral Clinic: The Impact of Out-of-Pocket Cost, Travel Distance, and Initial Treatment Progress. Adm Policy Ment Health 50, 834–847 (2023). https://doi.org/10.1007/s10488-023-01282-x
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DOI: https://doi.org/10.1007/s10488-023-01282-x