Abstract
This study compares behavioral health service utilization patterns and their determinants among Medicaid-enrolled children, ages 5–17 (N = 676) who were being served under managed care in Tennessee or a traditional fee-for-service system in Mississippi. Children in the fee-for-service program were significantly more likely than their counterparts in the managed care Medicaid program to receive behavioral health services (i.e., any service, support services, traditional outpatient services, day treatment, inpatient/residential care) and to receive more services overall. This finding held after controlling for the influence of other factors. Although child, family, and community variables were related to service use patterns, the relationships differed across systems. Caregiver strain was associated with several service use variables, but its influence was more pronounced in Tennessee. These findings support continued focus on the multi-level factors that shape behavioral health service use among children.
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Achenbach, T. M. (1991). Manual for the Child Behavior Checklist and 1991 Profile. Burlington: University of Vermont Department of Psychiatry.
Angold, A., Messer, S. C., Stangl, D., Farmer, E. M. Z., Costello, J., & Burns, B. J. (1998). Perceived parental burden and service use for child and adolescent psychiatric disorders. American Journal of Public Health, 88, 75–80.
Armbruster, P., & Fallon, T. (1994). Clinical, sociodemographic, and systems risk factors for attrition in a children's mental health clinic. American Journal of Orthopsychiatry, 64, 577–585.
Bickman, L., Guthrie, P. R., Foster, E. M., Lambert, E. W., Summerfelt, W. T., Breda, C. S., & Heflinger, C. A. (1995). Evaluating managed mental health services: The Fort Bragg experiment. New York: Plenum Press.
Bickman, L., Foster, E. M., & Lambert, E. W. (1996). Who gets hospitalized in a continuum of care. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 74–80.
Bird, H. R., Shaffer, D., Fisher, P., Gould, M. S., Staghezza, B., Chen, J. Y., & Hoven, C. (1993). The Columbia Impairment Scale: Pilot findings on a measure of global impairment for children and adolescents. International Journal of Methods in Psychiatric Research, 3, 167–176.
Brannan, A. M., & Heflinger, C. A. (2004). Barriers to care in children's mental health services. Paper presented at Building on Family Strengths Conference (Portland, OR), May 2004.
Brannan, A. M., & Heflinger, C. A. (2001). Distinguishing caregiver strain from psychological distress: Modeling the relationships among child, family, and caregiver variables. Journal of Child and Family Studies, 10, 405–418.
Brannan, A. M., Heflinger, C. A., & Bickman, L. (1997). The Caregiver Strain Questionnaire: Measuring the impact on the family of living with a child with serious emotional problems. Journal of Emotional and Behavioral Disorders, 5, 212–222.
Brannan, A. M., Heflinger, C. A., & Foster, E. M. (2003). The role of caregiver strain and other family variables in determining children's use of mental health services. Journal of Emotional and Behavioral Disorders, 11, 77–91.
Bui, K. T., & Takeuchi, D. T. (1992). Ethnic minority adolescents and the use of community mental health care services. American Journal of Community Psychology, 20(4), 403–417.
Burns, B. J., Costello, E. J., Angold, A., Tweed, D., Stangl, D., Farmer, E. M. Z., & Erkanli, A. (1995). Children's mental health service use across service sectors. Health Affairs, 14, 147–159.
Burns, B. J., Teagle, S. E., Schwartz, M., Angold, A., & Holtzman, A. (1999). Managed behavioral health care: A Medicaid carve-out for youth. Health Affairs, 18, 214–225.
Bussing, R., Zima, B. T., Gary, F. A., Mason, D. M., Leon, C. E., Sinha, K., & Garvan, C. W. (2003). Social networks, caregiver strain, and utilization of mental health services among elementary school students at high risk for ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 842–851.
Cook, J., Fitzgibbon, G., Burke-Miller, J., Mulkern, V., Grey, D. D., Heflinger, C. A., Paulson, R., Hoven, C. W., Stein-Seroussi, A., & Kelleher, K. (2004). Medicaid behavioral health care plan satisfaction and children's service utilization. Health Care Financing Review, 26, 43–55.
Farmer, E. M. Z., Burns, B. J., Angold, A., & Costello, E. J. (1997). Impact of children's mental health problems on families: Relationship with service use. Journal of Emotional and Behavioral Disorders, 5, 230–238.
Foster, E. M. (2000). Does the continuum of care reduce inpatient length of stay? Evaluation and Program Planning, 23, 53–65.
Foster, E. M. (1998). Does the continuum of care influence time in treatment? Evaluation Review, 22, 447–469.
Foster, E. M., Saunders, R. C., & Summerfelt, W. T. (1996). Predicting level of care in mental health services under a continuum of care. Evaluation and Program Planning, 23, 92–107.
Garland, A. F., Aarons, G. A., Brown, S. A., Wood, P. A., & Hough, R. L. (2003). Diagnostic profiles associated with use of mental health and substance abuse services among high-risk youths. Psychiatric Services, 54, 562–564.
Gilbert, M., Fine, S., & Haley, G. (1994). Factors associated with drop-out from group psychotherapy with depressed adolescents. Canadian Journal of Psychiatry, 39, 358–359.
Gould, M. S., Shaffer, D., & Kaplan, D. (1985). The characteristics of dropouts from a child psychiatry clinic. Journal of the American Academy of Child and Adolescent Psychiatry, 24, 316–328.
Heflinger, C. A., Simpkins, C. G., Northrup, D. A., Saunders, R. S. & Renfrew, W. (2000a). The Status of Mississippi Medicaid Children and Adolescents: Behavioral Health, Health, Service Use, and Consumer Satisfaction: The IMPACT Study Baseline Report on Interview Data. Nashville, TN: Vanderbilt Institute for Public Policy Studies, Center for Mental Health Policy.
Heflinger, C. A., Simpkins, C. G., Northrup, D. A., Saunders, R. S., & Renfrew, W. (2000b). The Status of TennCare Children and Adolescents: Behavioral Health, Health, Service Use, and Consumer Satisfaction: The IMPACT Study Baseline Report on Interview Data. Nashville, TN: Vanderbilt Institute for Public Policy Studies, Center for Mental Health Policy.
Heflinger, C. A., & Saunders, R. C. (in press). Physical and behavioral health of Medicaid children in two southern states. Southern Medical Journal.
Heflinger, C. A., Simpkins, C. G., Scholle, S. H., & Kelleher, K. (2003). Parent/caregiver satisfaction with their child's Medicaid plan and behavioral health providers. Mental Health Services Research, 6, 23–32.
Holden, E. W., Santiago, R. L., Manteuffel, B. A., Stephens, R., Brannan, A. M., Soler, R., Brashears, F., & Zaro, S. (2003). Systems of care demonstration projects: Innovation, evaluation and sustainability. In Pumariega, A. and Winters, N. (Eds.) Handbook of community systems of care: The new child and adolescent community psychiatry, (pp. 432–458). San Francisco, CA: Jossey Bass.
Hutchinson, A. B., & Foster, E. M. (2002) The effect of Medicaid managed care on mental health care for children: A review of the literature. Mental Health Services Research, 5, 39–54.
John, L. H., Offord, D. R., Boyle, M. H., & Racine, Y. A. (1995). Factors predicting use of mental health and social services by children 6–16 years old: Findings from the Ontario Child Health Study. American Journal of Orthopsychiatry, 65, 76–86.
Kaiser Family Foundation (2002). State Facts Online. http://www.statehealthfacts.kff.org
Kaminer, Y., Tarter, R. E., Bukstein, O. G., & Kabene, M. (1992). Comparison between treatment completers and noncompleters among dually diagnosed substance-abusing adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 1046–1049.
Kang, E. J., Brannan, A. M., & Heflinger, C. A. (2005). Racial differences in reports of caregiver strain among caregivers of children with emotional and behavioral problems. Journal of Child and Family Studies, 14, 43–56.
Lambert, D., & Agger, M. S. (1995). Access of rural AFDC medicaid beneficiaries to mental health services. Health Care Financing Review, 17, 133–145.
Lambert, E. W., Brannan, A. M., Heflinger, C. A., Breda, C., & Bickman, L. (1998). Common patterns of service use in children's mental health. Evaluation and Program Planning, 21, 47–57.
Long, S. (1997). Regression models for categorical and limited dependent variables. Thousand Oaks, CA: Sage.
Mandell, D. S., Boothroyd, R. A., & Stiles, P. G. (2003). Children's use of mental health services in different Medicaid insurance plans. Journal of Behavioral Health Services and Research, 30, 228–237.
McCabe, K., Yeh, M., Lau, A., Garland, A., & Hough, R. (2003). Racial/ethnic differences in caregiver strain and perceived social support among parents of youth with emotional and behavioral disorders. Mental Health Service Research, 5, 137–148.
McCubbin, H. I., & Patterson, J. M. (1983). The family stress process: The Double ABCX Model of adjustment and adaptation. Marriage and Family Review, 6, 7–37.
Mississippi Department of Mental Health (1997). Mississippi Department of Mental Health State Plan for Community Mental Health Services, FY 1997. Jackson, MS: Mississippi Department of Mental Health.
Mowbray, C. T., Grazier, K. L., & Holter, M. (2002). Managed behavioral health care in the public sector: Will it become the third shame of the states? Psychiatric Services, 53, 157–170.
Offord, D. R., Boyle, M. H., Szatmari, P., Rae-Grant, N. I., Links, P. S., Cadman, D. T., Byles, J., Crawford, J. W., Blum, H. M., Byrne, C., Thomas, H., & Woodward, C. A. (1987). Ontario child health study: II. Six-month prevalence of disroder an rates of service utilization. Archives of General Psychiatry, 44, 832–836.
Padgett, D. K., Patrick, C., Burns, B. J., & Schlesinger, H. J. (1994). Ethnic differences in use of inpatient mental health services by Blacks, Whites, and Hispanics in a national insured population. Health Services Research, 29, 135–153.
Padgett, D. K., Patrick, C., Burns, B. J., Schlesinger, H. J., & Cohen, J. (1993). The effect of insurance benefit changes on use of child and adolescent outpatient mental health services. Medical Care, 31, 96–110.
Patrick, C., Padgett, D. K., Burns, B. J., Schlesinger, H. J., and Cohen, J. (1993). Use of inpatient services by a national population: Do benefits make a difference? Journal of the American Academy of Child and Adolescent Psychiatry, 32, 144–152.
Realmutto, G. M., Bernstein, G. A., Maglothin, M. A., & Pandey, R. S. (1992). Patterns of utilization of outpatient mental health services by children and adolescents. Hospital and Community Psychiatry, 43, 1218–1223.
Saunders, R. C., & Heflinger, C. A. (2003). Access to and patterns of use of behavioral health services among children and adolescents in TennCare. Psychiatric Services, 54, 1364–1371.
Saunders, R. C., & Heflinger, C. A. (2004). Effects of Medicaid managed behavioral healthcare in the south. Health Care Financing Review, 26, 23–41.
Schneider, A., Fennel, K., & Long, P. (1998). Medicaid Eligibility for Families and Children. Washington, DC: Kaiser Commission on Medicaid and the Uninsured. Available at: www.kff.org/content/archive/2106/eligibility.pdf.
Stroul, B. A., Pires, S. A., Armstrong, M. I., & Meyers, J. C. (1998). The impact of managed care on mental health services for children and their families. The Future of Children, 8, 119–133.
Tabachnick, B. G., & Fidell, L. S. (1989). Using multivariate statistics (2nd Edn). NY: Harper Collins.
Tennessee Department of Finance and Administration, Bureau of TennCare (1999). TennCare Standard Operating Procedures (TSOP–36 & Addendum: Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)). Nashville, TN: Author.
U.S. Bureau of Census (2000). Census 2000 urban and rural classification. Available at http://www.census.gov/geo/www/ua/ua_2k.html.
Weil, A. (2003). There is something about Medicaid. Health Affair, 22, 13–30.
Wu, P., Hoven, C. W., Bird, H., Moore, R. E., Cohen, P., Alegria, M., Dulcan, M. K., Goodman, S. H., Horwitz, S. M., Lichtman, J. H., Narrow, W. W., Rae, D. S., Regier, D. A., & Roper, M. T. (1999). Depressive and disruptive disorders and mental health service utilization in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1081–1090.
Yatchmenoff, D. K., Koren, P. E., Friesen, B. J., Gordon, L. J., and Kinney, R. F. (1998). Enrichment and stress in families caring for a child with a serious emotional disorder. Journal of Child and Family Studies, 7, 129–145.
Zahner, G. E. P., Pawelkiewicz, W., DeFrancesco, J. J., & Adnopoz, J. (1992). Children's mental health service needs and utilization patterns in an urban community: An epidemiological assessment. Journal of the American Academy of Child and Adolescent Psychology, 31, 951–960.
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María Brannan, A., Heflinger, C.A. Child Behavioral Health Service Use and Caregiver Strain: Comparison of Managed Care and Fee-For-Service Medicaid Systems. Ment Health Serv Res 7, 197–211 (2005). https://doi.org/10.1007/s11020-005-7452-z
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DOI: https://doi.org/10.1007/s11020-005-7452-z