Association Between In-Home Treatment and Engagement in Psychosocial Services Among Medicaid-Enrolled Youth.

Abstract

Prior studies have identified low rates of engagement in mental health (MH) services in clinic settings among children enrolled in Medicaid. Yet, little is known about whether the delivery of in-home MH treatment (in which the clinician travels to the child's home) improves engagement for this population. This study examines the association between the delivery of in-home psychosocial treatment and engagement in services among Medicaid-enrolled youth. We used 2010 to 2014 Georgia Medicaid claims data to identify 53,508 children and adolescents (aged 5-17 years) with a MH diagnosis that initiated new psychosocial treatment. We estimated regression models controlling for covariates to examine the relationship of the receipt of any in-home psychosocial treatment in the home setting with 3 outcome measures of engagement: receipt of at least 4 psychosocial visits during the first 12 weeks; total number of psychosocial visits during the first 12 weeks; and total duration of service use. Those who received any in-home psychosocial treatment (compared to those who did not) had 4.3 times the odds (odds ratio= 4.3, 95% CI= 4.0, 4.7) of receiving at least 4 visits during the first 12 weeks, had 4.5 (95% CI= 4.3, 4.7) more predicted visits during the first 12 weeks, and had a longer treatment episode duration (mean rate ratio= 1.54, 95% CI= 1.48,1.59). Although many Medicaid-enrolled youth do not receive a sufficient number of MH services to achieve positive outcomes, our findings suggest that providing in-home psychosocial treatment can improve service engagement and potentially help address this challenge.