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J Am Acad Child Adolesc Psychiatry. 2016 Jan;55(1):69-76.e3. doi: 10.1016/j.jaac.2015.09.020. Epub 2015 Oct 14.

Access to Psychosocial Services Prior to Starting Antipsychotic Treatment Among Medicaid-Insured Youth.

Author information

1
New York University Langone Medical Center, New York, and New York State Office of Mental Health, Albany. Electronic address: Molly.Finnerty@omh.ny.gov.
2
Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes/Institute for Health, Rutgers University, New Brunswick, NJ.
3
New York State Office of Mental Health, Albany.
4
New York State Office of Mental Health and School of Public Health, State University of New York at Albany.
5
National Committee for Quality Assurance, Washington, DC.
6
College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York.

Abstract

OBJECTIVE:

To examine rates and predictors of receiving a psychosocial service before initiating antipsychotic treatment among young people in the Medicaid program.

METHOD:

A retrospective new-user cohort study of 8 state Medicaid programs focused on children and adolescents 0 to 20 years, initiating antipsychotic treatment (N = 24,372). The proportion receiving a psychosocial service in the 3 months before initiating antipsychotic treatment was calculated and stratified by socio-demographic and diagnostic characteristics arranged in 9 hierarchical groups, as follows: developmental, psychotic/bipolar, disruptive, attention-deficit/hyperactivity, obsessive-compulsive, stress, major depressive, anxiety, and other disorders.

RESULTS:

Less than one-half of youth received a psychosocial service before initiating antipsychotic treatment (48.8%). Compared to younger adolescents (12-17 years) initiating antipsychotic treatment (51.5%), corresponding younger children (0-5 years; 39.2%) and older adolescents (18-20 years; 40.1%), but not older children (6-11 years; 51.5%), were significantly less likely to have received a psychosocial service. In relation to youth diagnosed with psychotic or bipolar disorder (52.7%), those diagnosed with attention-deficit/hyperactivity (43.3%), developmental (41.4%), depressive (46.5%), or anxiety (35.6%) disorder were significantly less likely to have received a psychosocial service during the 3 months before antipsychotic initiation. By contrast, youth diagnosed with stress disorders (61.2%) were significantly more likely than those diagnosed with psychotic or bipolar disorders (52.7%) to have received a psychosocial service before starting an antipsychotic.

CONCLUSION:

A majority of Medicaid-insured youth initiating antipsychotic treatment have not received a psychosocial service in the preceding 3 months. This service pattern highlights a critical gap in access to psychosocial services.

KEYWORDS:

access to care; antipsychotic treatment; children; prescribing practices; psychotherapy

PMID:
26703912
DOI:
10.1016/j.jaac.2015.09.020
[Indexed for MEDLINE]
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