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PM R. 2013 Dec;5(12):1026-34. doi: 10.1016/j.pmrj.2013.08.589. Epub 2013 Aug 22.

Behavioral predictors of outpatient mental health service utilization within 6 months after traumatic brain injury in adolescents.

Author information

  • 1Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, 3333 Burnet Ave. MLC 4009, Cincinnati, OH 45229-3039(∗). Electronic address: brad.kurowski@cchmc.org.
  • 2Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH(†).
  • 3Department of Physical Medicine and Rehabilitation, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO(‡).
  • 4Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN(§).
  • 5Division of Pediatric Psychology, Department of Psychiatry, MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH(¶).
  • 6Division of Developmental and Behavioral Pediatrics and Psychology, Department of Pediatrics, Case Western Reserve University and Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, OH(‖).

Abstract

OBJECTIVES:

To characterize utilization of mental health services and determine the ability of a behavior problem and clinical functioning assessment to predict utilization of such services within the first 6 months after moderate and severe traumatic brain injury in a large cohort of adolescents.

DESIGN:

Multicenter cross-sectional study.

SETTING:

Outpatient setting of 4 tertiary pediatric hospitals, 2 tertiary general medical centers, and 1 specialized children's hospital.

PARTICIPANTS:

Adolescents age 12-17 years (n = 132), 1-6 months after moderate-to-severe traumatic brain injury.

METHODS:

Logistic regression was used to determine the association of mental health service utilization with clinical functioning as assessed by the Child and Adolescent Functional Assessment Scale and behavior problems assessed by the Child Behavioral Checklist.

MAIN OUTCOME MEASUREMENT:

Mental health service utilization measured by the Service Assessment for Children and Adolescents.

RESULTS:

Behavioral or functional impairment occurred in 37%-56%. Of the total study population, 24.2% reported receiving outpatient mental health services, 8.3% reported receiving school services, and 28.8% reported receiving any type of mental health service. Use of any (school or outpatient) mental health service was associated with borderline to impaired total Child and Adolescent Functional Assessment Scale (odds ratio 3.50 [95% confidence interval, 1.46-8.40]; P < .01) and the Child Behavioral Checklist Total Competence (odds ratio 5.08 [95% confidence interval, 2.02-12.76]; P < .01).

CONCLUSIONS:

A large proportion of participants had unmet mental health needs. Both the Child and Adolescent Functional Assessment Scale and the Child Behavioral Checklist identified individuals who would likely benefit from mental health services in outpatient or school settings. Future research should focus on methods to ensure early identification by health care providers of adolescents with traumatic brain injury in need of mental health services.

Copyright © 2013 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

PMID:
23973505
[PubMed - indexed for MEDLINE]
PMCID:
PMC3878718
Free PMC Article
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