Characterizing behavioral health-related emergency department utilization among children with Medicaid: Comparing high and low frequency utilizers

Abstract

While the frequency of children's behavioral health (BH)related visits to the emergency department (ED) is rising nationwide, few studies have examined predictors of high rates of ED use. This study examines Florida Medicaid claims (2011)(2012) for children age 0-18 who were seen in an emergency department (ED) for behavioral health (BH) conditions. A logistic regression model was used to explore factors associated with frequent ED use and patterns of psychotropic medication utilization. The majority (95%) of patients with at least one BH-related ED visit had three or fewer of these visits, but 5% had four or more. Seventy-four percent of ED visits were not associated with psychotropic medication, including over half (54%) of visits for attention deficit hyperactivity disorder (ADHD). Frequent ED use was higher among older children and those with substance use disorders. The implementation of interventions that reduce non-emergent ED visits through the provision of care coordination, social work services, and/or the use of community health workers as care navigators may address these findings.

Associations between outpatient treatment and the use of intensive psychiatric healthcare services

“…Over the past two decades youth utilization of inpatient and crisis psychiatric services has increased. Between 2011 and 2015, there was a 28% increase in behavioral health-related emergency department (ED) visits among youth, with these visits accounting for up to 7% of all ED visits (Carubia et al, 2016; Kalb et al, 2019; Lynch et al, 2019). Estimated utilization rates of non-ED inpatient psychiatric services, including short-term inpatient facilities and longer-term residential facilities appear to have doubled from 2006 to 2011 (Torio et al, 2015).…”

“…Despite literature on rates of – and risk factors for - behavioral health service utilization, fewer studies have used administrative data to examine the relationship between outpatient and more intensive or crisis service use (Bryson & Akin, 2015; Cloutier et al, 2017; Leon et al, 2017; Lynch et al, 2019). Past studies so far suggest that outpatient behavioral health access or utilization increases youth risk for ED and inpatient service utilization (Bryson & Akin, 2015; Cloutier et al, 2017; Leon et al, 2017).…”