A Comparison Study of Primary Care Utilization and Mental Health Disorder Diagnoses Among Children In and Out of Foster Care on Medicaid

Keefe, Rachael J.; Horne, Bethanie S. Van; Cain, Cary; Budolfson, Katherine; Thompson, Richard; Greeley, Christopher S.

doi:10.1177/0009922819898182

Cited by 9 publications

(3 citation statements)

References 18 publications

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“…Previous studies have found a strong association between foster care and mental health problems in children [ 23 – 25 ]. The results in this study showed that the probability of utilizing child protection services increased immediately during the quarter of the initial diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…One reason could be that mental health diagnoses are typically more prevalent in vulnerable populations. For example, the probability of mental health diagnoses in children placed in out-of-home care (foster care) is considerably higher [ 23 – 25 ]. Despite the higher utilization of services, treatment gaps seem to persist in mental health conditions [ 26 ].…”

Section: Introductionmentioning

confidence: 99%

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Association of mental health and behavioral disorders with health care and service utilization in children before and after diagnosis

Nurminen

2022

PLoS ONE

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Mental health is one of the most important contributors to the global burden of disease in children and adolescents. Mental health conditions are associated with lower quality of life in adulthood. These conditions have an early onset and typically first occur in childhood. However, little is known about how these conditions are related to service utilization before the initial diagnosis, or about the significance of the diagnosis on later service utilization. To study this, register data on 5-15-year-old children in the city of Oulu, Finland, covering the years 2013–2018 were used. To identify the association of mental health and behavioral conditions with service utilization, counterfactuals were constructed from children who were similarly diagnosed three years later. Event study regressions on several health care and service utilization outcomes were estimated. The findings showed that primary and specialized health care utilization increased sharply before the initial diagnosis and peaked during the time of diagnosis. Primary care utilization started decreasing slowly after, while specialized health care utilization remained high for two years after the diagnosis. Probability of visiting a mental health professional, use of rehabilitation services, psychiatric medication, and utilization of child protection services increased significantly after the diagnosis. The results highlighted the importance of outpatient health care in detecting and treating the conditions in children. In a fragmented system, knowledge on utilization trajectories in different services may be of help in allocating resources to improve the health of these children.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association of mental health and behavioral disorders with health care and service utilization in children before and after diagnosis

Nurminen

2022

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…Instead, electronic health records (EHRs), interviews and parent/self-reports, chart reviews, and questionnaires were more typically used. 4,5,[21][22][23][24] Although not without its limitations, claims data allow us to ascertain all diagnoses for which a claim was submitted for all types of health care providers and locations, including emergency, inpatient, urgent, primary, specialty, and home care. This is more comprehensive than the use of an EHR, in which data are limited to encounters in that specific health clinic or system.…”

Section: Discussionmentioning

confidence: 99%

Mental Health and Developmental Disorder Diagnoses of Foster and Nonfoster Children Enrolled in Medicaid

Keefe

Cummings

Greeley

et al. 2021

J Dev Behav Pediatr

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Objective: This study used Medicaid claims to compare the prevalence of mental health disorders (MHDs) and developmental disorders (DDs) between foster and nonfoster youth. Methods: Medicaid claims data were used to identify MHDs and DDs. Diagnosis codes were categorized into 16 MHD and 8 DD groups.Children were enrolled in their respective Medicaid plan for at least 30 days and had at least 1 health care encounter generating a claim. Prevalence was compared between children in foster care and children not in foster care overall and by age group. Logistic regression was used to compare the odds of having an MHD or DD diagnosis. Results: Of the 8706 children in foster care, 20.1% had an MHD compared with 9.7% of the 392,815 nonfoster children. Overall, the 5 most prevalent MHD and DD conditions among foster youth were attention-deficit/hyperactivity disorder (ADHD) (11.0%), miscellaneous (9.3%), bipolar disorders (5.6%), communication disorders (5.4%), and depressive disorders (5.1%). The 5 most prevalent conditions among children not in foster care were ADHD (6.1%); communication disorders (3.0%); disruptive, impulse control, and conduct disorders (2.7%); specific learning disorders (2.5%); and trauma and stressor-related disorders (2.4%). Anxiety was significantly higher among nonfoster children. The prevalence of the most common conditions by age group is reported. Overall, children in foster care had 2.5 and 2.3 times higher odds of having an MHD or DD diagnosis, respectively. Conclusion: Children in foster care had significantly higher rates of mental health and DD diagnoses compared with children not in foster care.

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Primary Care and Behavioral Health Services Use Differ Among Medicaid-Enrolled Children by Initial Foster Care Entry Status

Kaferly

Orsi

Alishahi³

et al. 2022

Int. Journal on Child Malt.

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Most children in foster care have poor health outcomes and high health care utilization. Health complexity influences health care utilization as well foster care placement. Health care utilization studies among children in foster care have not accounted for health complexity status and foster placement. A 7-year retrospective study linked Colorado child welfare and Medicaid administrative data for 30,164 Medicaid-enrolled children, up to 23 years old, who differed by initial foster care entry, to examine primary care and behavioral health (BH) utilization patterns from 2014 to 2021. Children entering care were matched with replacement to non-foster peers by age, sex, Medicaid enrollment patterns, managed care status, family income, and health complexity. We calculated weighted monthly average percentages of children with primary care and BH utilization by foster care entry, health complexity, sex, and age over 25 months relative to the month of foster care entry for the foster cohort or the reference month for non-foster peers. Children in the foster cohort had lower primary care but higher BH utilization relative to non-foster peers prior to the reference month. Primary care and BH use increased among children in foster care during and 12 months after the reference month, unlike matched comparisons. Primary care and BH utilization increased by health complexity but differed by foster care status and time. Foster care entry and health complexity produced distinct patterns of primary care and BH utilization. Given higher utilization among children in foster care, future investigation should explore health care quality and delivery factors.

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A Comparison Study of Primary Care Utilization and Mental Health Disorder Diagnoses Among Children In and Out of Foster Care on Medicaid

Cited by 9 publications

References 18 publications

Association of mental health and behavioral disorders with health care and service utilization in children before and after diagnosis

Association of mental health and behavioral disorders with health care and service utilization in children before and after diagnosis

Mental Health and Developmental Disorder Diagnoses of Foster and Nonfoster Children Enrolled in Medicaid

Primary Care and Behavioral Health Services Use Differ Among Medicaid-Enrolled Children by Initial Foster Care Entry Status

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