Defining and Predicting High Cost Utilization in Children's Outpatient Mental Health Services.

Little is known about high-cost service users in the context of youth outpatient mental health, despite the fact that they account for a large proportion of overall mental healthcare expenditures. A nuanced understanding of these users is critical to develop and implement tailored services, as well as to inform relevant policies. This study aims to characterize high-cost service users by examining demographic factors, diagnoses, and service type use. Administrative service use data were extracted from a large County Department of Behavioral Health Services database. Latent profile analyses suggest a four-profile solution primarily distinguished by youth age and diagnostic complexity. Study findings have implications for defining high-cost service users and key targets for efforts aiming to improve outcomes for these youth.

The Parent Participation Engagement Measure (PPEM): Reliability and Validity in Child and Adolescent Community Mental Health Services.

Parent participation in community-based child mental health services is an important yet understudied process associated with treatment effectiveness. This paper describes the development and psychometrics of the Parent Participation Engagement Measure in a sample of 1374 parents and 563 youth receiving publicly-funded mental health services. Analyses indicated excellent internal consistency, and model fit indices/factor loadings supported a one-factor model. Convergent and discriminant validity were supported, although some coefficients were modest in magnitude. Psychometric results were consistent for Caucasian versus Hispanic, parent versus youth, and English versus Spanish-language respondents. The clinical and research utility of this measure are discussed.

Are children improving? Results from outcome measurement in a large mental health system.

Standardized outcome assessment was implemented in a large county mental health system. This study examines changes in children's emotional and behavioral problems after 6 months of treatment and identifies factors associated with treatment improvement. Results from 3,215 youth indicated that externalizing and internalizing problems significantly decreased from intake to 6 months and that ethnicity, gender, and age were associated with caregiver-reported changes in symptomatology. While there was improvement associated with entry into treatment, the magnitude of symptom reduction was small to medium and not associated with amount of care, providing only limited support for the impact of routine out-patient care.

Treatment Effects for Common Outcomes of Child Sexual Abuse: A Current Meta-Analysis.

The present meta-analysis examined the effects of psychosocial treatments at reducing deleterious outcomes of sexual abuse. The meta-analysis included a total of 35 published and unpublished studies written in English, focusing on youth under the age of 18, and evaluating the effectiveness of treatments for the most common negative outcomes of sexual abuse: PTSD symptoms, externalizing problems, and internalizing problems. Results revealed medium effect sizes for PTSD symptoms, externalizing problems, and internalizing problems following treatment for sexual abuse. This study also examined the potential moderating effects of treatment (e.g., modality, duration, inclusion of caregiver) and participant (e.g., age, gender, ethnicity) characteristics. Results indicated that longer interventions were associated with greater treatment gains while group and individual treatments were equally effective. These findings shed new light on treatment effectiveness and provide useful information regarding the conditions under which treatment may be most effective. Future directions for research in this area are discussed.

The impact of changing neighborhoods, switching schools, and experiencing relationship disruption on children's adjustment to a new placement in foster care.

When children enter a new foster care placement they may experience several different transitions. Not only will a child move in with a new family, he or she may move to a different neighborhood, change schools, lose contact with old friends, be placed apart from one or more siblings, and have limited contact with his or her biological parents. The current study examined the impact of these transitions on foster children's adjustment to a new placement in out-of-home care. The sample consisted of 152 youth ages 6-17.5 who participated in the second National Survey of Child and Adolescent Well-Being (NSCAW II) study and who were residing with relative or non-relative foster families at the time of the Wave I interview. During the Wave I interview, youth were asked to report on the types of transitions they experienced when they moved into their current placement. Linear and Poisson regressions were used to estimate the effect of the transitions on youths' relationships with their new families, mental health, relationships with peers at school, and school engagement. The results showed that youth whose biological mothers contacted them more than once a month had more symptoms of mental health problems than youth who had less contact with their biological mothers. In contrast, changing schools had a positive impact on youths' mental health, and youth who were separated from siblings were more likely to get along well with their school peers. Implications for improving youth's adjustment to new foster care placements are discussed.

Do aftercare mental health services reduce risk of psychiatric rehospitalization for children?

Appropriate and timely aftercare services are considered critical for children and adolescents with previous psychiatric hospitalization. The purpose of the present study was to investigate the relationship between type and amount of aftercare received and rehospitalization among youths who have been previously hospitalized due to psychiatric illness. The sample consisted of 569 youth ages 6-18 who received services in a large public service system. The sample of youth was 58% female and consisted largely of ethnic minorities (51% Hispanic, 26% White, 16% African American, and 7% were another race/ethnicity). Demographic, diagnostic, and service use data was obtained from billing records. Time-dependent Cox regression models evaluated the impact of aftercare (the primary dependent variable of interest) on risk of rehospitalization. Separate models were analyzed for each type of service and all models were adjusted for race/ethnicity, age, gender, diagnosis, insurance status, and comorbid substance use. Seventy percent of youths with a psychiatric hospitalization received aftercare and 28% were rehospitalized within 6 months of discharge. The total hours of services youths received was significantly related to a smaller likelihood of rehospitalization. Having a diagnosis of schizophrenia was associated with a higher risk of rehospitalization and receiving more days of day treatment was associated with a lower risk of rehospitalization. Given the restrictiveness and cost of hospitalization, mental health practitioners should focus on improving access, engagement, and quality of aftercare services. (PsycINFO Database Record

Caregiver participation in community-based mental health services for children receiving outpatient care.

Caregiver participation in child mental health treatment has been associated with better youth outcomes, but little is known about the amount and type of caregiver participation in usual care services for children. This study examined 1,255 caregivers' reports of their participation in the outpatient services their children received through a large, public mental health system in the Southwest. The majority of the caregivers reported that they participated in their child's services. Extent of participation was associated with several factors including children's physical health and caregivers' primary language, satisfaction with the services, feelings of support, and perceptions of barriers to participation. The findings offer some encouragement for the contextual fit for many evidence-based interventions that focus on caregiver involvement, and highlight which caregivers may need greater encouragement to participate in their child's care.