Access to and Patterns of Use of Behavioral Health Services Among Children and Adolescents in TennCare

Heflinger, Craig Anne

doi:10.1176/appi.ps.54.10.1364

Cited by 31 publications

(25 citation statements)

References 26 publications

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“…In fact, studies on Medicaid populations (Callahan, Shepard, Beinecke, Larson, & Cavanaugh, 1995;Dickey, Normand, Norton, Rupp, & Azeni, 2001;Saunders & Heflinger, 2003) have shown increases…”

Section: Abstract Inpatient Psychiatric Hospitalization; Adolescents;mentioning

confidence: 99%

The influence of clinical, treatment, and healthcare system characteristics on psychiatric readmission of adolescents.

Fontanella

2008

American Journal of Orthopsychiatry

103

124

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This study examined predictors of readmission for a sample of 522 adolescents enrolled in Medicaid and admitted to three inpatient psychiatric hospitals in Maryland. Comprehensive data on clinical, treatment, and health care system characteristics were collected from archival sources (medical records, Medicaid claims, and Area Resource File). Predictors of readmission were examined with bivariate (Kaplan Meier) and multivariate (Cox Regression) survival techniques. One year readmission rates were 38% with the majority occurring within 3 months after discharge. Adolescent demographic (age and gender), clinical (severity of symptoms, comorbidity, suicidality) and family characteristics (level of family risk) were associated with readmission. However, treatment factors including type of aftercare, post-discharge living environment, medication noncompliance, and hospital provider were among the strongest predictors of readmission. Study findings underscore the importance of careful discharge planning and linkage to appropriate aftercare. The differing rates of readmission across hospitals also suggest that organizational level factors may play a vital role in determining treatment outcomes. Keywords inpatient psychiatric hospitalization; adolescents; readmissionIt is estimated that 24% to 37% of youths will be readmitted to a psychiatric hospital within one year after discharge, and latest data suggest that rates of readmission are increasing despite cost-containment efforts and emphasis on community-based treatment alternatives (Blader, 2004;Fontanella, Zuravin, & Burry, 2006;Pavkov, Goerge, Lee, & Howard, 1994; Soloman, Evans, & Delaney, 1993). In the United States, inpatient services account for about 33% ($3.9 billion) of the total mental health expenditures for children and adolescents; across age groups adolescents are the highest users of inpatient services (Ringel & Sturm, 2001).Some researchers speculate that the increased readmission rates can be attributed to premature discharges resulting from shortened lengths of stay (Appley, Desai, Luchins, Gibbons, & Hedeker, 1993;Lien, 2002;Wickizer, Lessler, & Boyd-Wickizer, 1999). In fact, studies on Medicaid populations (Callahan, Shepard, Beinecke, Larson, & Cavanaugh, 1995;Dickey, Normand, Norton, Rupp, & Azeni, 2001;Saunders & Heflinger, 2003) have shown increasesCorrespondence concerning this article should be addressed to Cynthia A. Fontanella, College of Social Work, The Ohio State University, 1947 College Road, Columbus, Ohio 43210. E-mail: fontanella.4@osu.edu. Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. ...

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Section: Abstract Inpatient Psychiatric Hospitalization; Adolescents;mentioning

confidence: 99%

The influence of clinical, treatment, and healthcare system characteristics on psychiatric readmission of adolescents.

Fontanella

2008

American Journal of Orthopsychiatry

103

124

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“…The study concluded that community treatment was not a substitute for inpatient care in the treatment of children with emotional and behavioral problems [103].…”

Section: Tennesseementioning

confidence: 99%

The Premature Demise of Public Child and Adolescent Inpatient Psychiatric Beds

Geller

Biebel²

2006

Psychiatr Q

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Current trends on the national landscape of available treatment and delivery systems for children and adolescents with serious emotional disturbance indicate a sharp decline in the availability of inpatient psychiatric services. These trends are troubling as six to nine million children and adolescents in the United States suffer from some serious emotional disturbance, and the majority in need of treatment do not receive behavioral health services. The consequences of untreated mental illness in children are grave, and the cost to society of children's mental health problems is high in both human and fiscal terms. This paper will describe national trends in behavioral health in general and specifically children's mental health, and will detail the experiences of many states to identify possible problems and pitfalls to downsizing and closing child and adolescent inpatient psychiatric beds.

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“…5 Despite the rapid infiltration of managed care into the public sector and concerns about quality of care, surprisingly little is known about the effects of Medicaid managed care programs on patterns of mental health care for children. [6][7][8][9] To date, the majority of studies have focused predominantly on adults, yet children, especially those with serious emotional disturbances, may be particularly vulnerable to poorer outcomes within managed care because of their unique characteristics. 8,10,11 Children with emotional and behavioral disorders have complex needs and require a broad array of services from multiple professionals; often, high intensity services over extended periods of time and involvement from multiple systems including public mental health, child welfare, and juvenile justice are necessary.…”

Section: Introductionmentioning

confidence: 99%

The Effect of a Medicaid Managed Care Program on Patterns of Psychiatric Readmission Among Adolescents: Evidence from Maryland

Fontanella

Zuravin²,

Burry³

2006

J Behav Health Serv Res

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This study evaluates the effect of Maryland's Medicaid managed care program on patterns of psychiatric readmission for adolescents. Rates and frequency of readmissions are compared before (FY 1997) and after (FY 1998) the implementation of Maryland's Medicaid managed care program. Medicaid claims files were reviewed for 881 adolescents consecutively admitted to three major Maryland psychiatric hospitals between July 1, 1996 and June 30, 1998. Adolescents admitted after the managed care reforms were more likely to experience multiple readmissions. The 1-year cumulative rate of readmission pre- and postmanaged care was 33% and 38%, respectively; the highest risk period fell within the first 15-30 days postdischarge. The high rate of early readmissions raises concern about the quality of care and the adequacy of community-based services. Findings also suggest that youths with serious emotional disturbances who are high users of inpatient care may be adversely affected by the managed care reforms.

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Access to and Patterns of Use of Behavioral Health Services Among Children and Adolescents in TennCare

Cited by 31 publications

References 26 publications

The influence of clinical, treatment, and healthcare system characteristics on psychiatric readmission of adolescents.

The influence of clinical, treatment, and healthcare system characteristics on psychiatric readmission of adolescents.

The Premature Demise of Public Child and Adolescent Inpatient Psychiatric Beds

The Effect of a Medicaid Managed Care Program on Patterns of Psychiatric Readmission Among Adolescents: Evidence from Maryland

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