34.1 Improving Equity in Child Mental Health Outcomes

Abstract

The aim of this study is to investigate the impact of pediatric integrated care, including peer-to-peer family support, on outcomes for children with mental health needs in a multicultural, urban safety-net system. We conducted a prospective, quasi-experimental clinical trial comparing health service utilization and spending between children nonrandomly assigned (at the clinic level) to the intervention or to usual care. We analyzed service-use data in 30-day segments for 12 months pre-post initial evaluation. Outcome variables were mental health, pediatric, and pharmacy utilization. The main explanatory variables were treatment group, time, and their interaction. In addition, we examined within-group changes (pre-post) on standardized measures of clinical functioning. Intervention youths were more likely to: be Black or Hispanic (61% vs 43%; p < 0.001); speak Spanish or Portuguese (52% vs 32%; p < 0.001); and carry multiple mental health diagnoses at baseline (42% vs 30%; p = 0.009). Doubly robust estimation results indicated that the intervention group had a 36% larger pre-post gain in outpatient mental health utilization (+15.6 pts.; standard error [SE] = 6.7) but no difference in outpatient mental health spending compared to controls. Intervention youths had 20% pre-post reductions in ED admissions (–5.6 pts.; SE = 2.2) and outpatient PH utilization (–19.2 pts.; SE = 5.2). The control group experienced no significant changes. Within-group analyses of clinical functioning, including measures of self-harm, revealed statistically significant improvement from baseline to 6 months and again from 6 months to 12 months. Overcoming mental healthcare access barriers for children and families, often mediated by structural racism, requires new models of care. In addition to significant clinical change on longitudinal measures, for the intervention group, evidence from propensity-score–weighted analyses indicate service use changes consistent with reduced health status inequity.