Abstract
The current study (1) characterizes patterns of mental health service utilization over 8 years among youth who received psychotherapy in the context of a community implementation of multiple evidence-based practices (EBPs), and (2) examined youth-, provider- and service-level predictors of service use patterns. Latent profile analyses were performed on 5,663,930 administrative claims data furnished by the county department of mental health. Multinomial logistic regression with Vermunt’s method was used to examine predictors of care patterns. Based on frequency, course, cost, and type of services, three distinct patterns of care were identified: (1) Standard EBP Care (86.3%), (2) Less EBP Care (8.5%), and (3) Repeated/Chronic Care (5.2%). Youth age, ethnicity, primary language, primary diagnosis and secondary diagnosis, provider language and provider type, and caregiver involvement and service setting were significant predictors of utilization patterns. Although the majority of youth received care aligned with common child EBP protocols, a significant portion of youth (13.7%) received no evidence-based care or repeated, costly episodes of care. Findings highlight opportunities to improve and optimize services, particularly for youth who are adolescents or transition-aged, Asian-American/Pacific Islander, Spanish-speaking, or presenting with comorbidities.
Highlights
Representative surveys estimate that 13% of children and adolescents suffer from a mental health disorder in the U.S, but only a third to a half of these youth receive services (Merikangas et al, 2010, 2011)
Whereas 20.1% of therapists reported not having completed the evidence-based practices (EBPs) with the client, 21.2% of therapists reported that the client’s treatment discontinued after completing the EBP, and 58.7% of therapists reported continuing therapy. These findings suggest that service utilization patterns may influence EBP delivery in routine care
The current study extends the children’s mental health services and implementation research literature by (1) characterizing patterns of mental health service utilization among youth receiving psychotherapy using latent profile analyses within a system employing multiple EBPs, (2) focusing on the largest county public mental health service system in the U.S serving youth with a variety of common presenting concerns, and (3) exploring patterns of care over 8 years of a community EBP implementation initiative
Summary
Representative surveys estimate that 13% of children and adolescents suffer from a mental health disorder in the U.S, but only a third to a half of these youth receive services (Merikangas et al, 2010, 2011). Among youth who initiate services, evidence suggests that the continuity of that care is poor. A recent report from Mental Health America found that only 27% of youth with severe depression accessed more than seven visits total in the past year (Mental Health America, 2020). Such sobering figures highlight the continued need to address mental health care gaps among children and adolescents
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