Access to medicaid providers: availability of mental health services for children and adolescents in child welfare in Louisiana

Abstract

The purpose of the study was to determine the level of access that youths in child welfare have to mental health providers in a single state. Mystery shoppers called every provider publicly advertised in Medicaid managed care organization networks. Results showed that 25.4% of the advertised network was able to schedule a new appointment for a child in Department of Children and Family Services guardianship. There were 9.7 accessible providers of any discipline (MD, PhD, or licensed masters-level clinician) per 10,000 Medicaid-enrolled youths in the population. The level of access to MDs was 4.1 times lower than the nationallyrecommended level.

Implementation and Mental Health Outcomes of a Service Cascade Linking Child Welfare and Children’s Mental Health Systems: A Case Study of the Gateway CALL Demonstration

“…Bunger et al, 2009 ), limited mental health treatment availability and long waitlists for care (e.g. Barnett et al, 2018 ; Scheeringa et al, 2020 ; Steinman et al, 2012 ), or the challenges foster parents experience in bringing children to appointments (because the child refused, the provider was too far, scheduling, concerns about appropriateness, etc.) (Cao et al, 2019 ; Pasztor et al, 2006 ).…”

“…For instance, child welfare workers might be untrained and unfamiliar with mental health issues (Dorsey et al, 2012 ), and find it difficult to prioritize children’s mental health service needs amid pressure to respond to safety concerns (Hoffman et al, 2016 ; Perez Jolles et al, 2019 ; Smith & Donovan, 2003 ). Even when child welfare workers identify children’s treatment needs, children can fail to receive care if workers are unfamiliar with treatment options (Bunger et al, 2009 ; Stiffman et al, 2000 , 2004 ) or when there is limited availability of high quality, evidence-based treatment among providers who accept Medicaid (which covers services for children in out-of-home care) (Bruns et al, 2016 ; Scheeringa et al, 2020 ; Steinman et al, 2012 ). Attending to these barriers across both child welfare and mental health settings could potentially improve children’s mental health service access and their well-being.…”

Low availability, long wait times, and high geographic disparity of psychiatric outpatient care in the US

“…[16] Current mystery shopper studies are limited to small sample sizes, local or regional investigations or specific patient populations. [17][18][19] The latest mystery shopper study that investigated general psychiatric care with multiple sampling sites was published in 2015, which was before the COVID-19 pandemic onset. [3] Not every mystery shopper study includes wait time and directory accuracy as outcomes, despite being significant factors for successful appointments and continuity of care.…”