The Impact of a Primary Care Telepsychiatry Program on Outcomes of Managed Care Older Adults.

OBJECTIVE: The goal of this study was to assess the outcomes of a primary-based telepsychiatry intervention program for older managed care enrollees with depression/anxiety and with limited access to in-person psychiatric care. DESIGN: A pre-post design was used to examine service use (n = 218) and severity of depression (n = 204). Enrollment, claims, and depression and anxiety score data were obtained from the medical group. The implementation process and self-reported outcomes were examined. SETTING AND PARTICIPANTS: The program was funded by the Senior Care Action Network (SCAN) group and implemented by a large medical group serving older adults who were identified as needing outpatient psychiatric care, including those with psychiatric hospitalizations, depression/anxiety disorders, comorbid substance use disorders, or other multiple comorbidities. METHODS: Poisson regressions were used to examine changes in predicted rates of outpatient services, emergency department visits, and hospitalizations up to 24 months prior and 24 months following the first telepsychiatry visit. Changes in predicted severity of depression up to 2 quarters prior and 3 quarters following the first telepsychiatry visit were examined. RESULTS: The number of outpatient services declined significantly by 0.24 per patient per 6-month time frame following the first telepsychiatry visit. The number of emergency department visits and hospitalizations also declined after the first visit (0.07 and 0.03 per patient per 6-month time frame, respectively). Depression severity scores also declined in the quarters following the first visit (1.52). The medical group reported improvements in both wait time for appointments and no-show rates with the integration of telepsychiatry in primary care. CONCLUSIONS AND IMPLICATIONS: The telepsychiatry program lowered service use, depression severity, and increased better access to psychiatry care. The findings highlight the potential benefits of sustaining and expanding the telepsychiatry program by SCAN and other plans facing a limited supply of psychiatrists.

Three out of four children with mental health needs in California do not receive treatment despite having health care coverage.

More than 300,000 California children ages 4 to 11 have mental health needs, yet only one-fourth of them received mental health care in 2007 and 2009. Health insurance coverage and a usual source of care typically facilitate mental health service use; however, this is not the case for children with mental health needs. This policy brief identifies children at risk for mental health needs and highlights some barriers to their receiving mental health services. Childhood is a vital time for the promotion of positive mental health among children, as well as for supporting at-risk families in order to avert the early onset of some disorders and help reduce the severity of others. To reduce the potential burden and lifelong difficulties of untreated mental health needs, it is critical that mental health problems in young children be identified and addressed early.

Older adults challenged financially when adult children move home.

This policy brief looks at the financial burdens imposed on older Californians when adult children return home, often due to a crisis not of their own making, to live with their parents. The findings show that on average in California, the amount of money that older adults need in order to maintain a minimally decent standard of living while supporting one adult child in their home increases their expenses by a minimum of 50 percent. Low-income older adults are usually on fixed incomes, so helping an adult child can provide the child with a critical safety net but at the cost of the parents' own financial well-being. Policy approaches to assisting this vulnerable population of older adults include implementing reforms to increase Supplemental Security Income (SSI), improving the availability of affordable housing, assuring that all eligible nonelderly adults obtain health insurance through health care reform's expansion of Medi-Cal and subsidies, and increasing food assistance through SNAP and senior meal programs.

Economic need among older Latinos: applying the Elder Economic Security Standard™ Index.

The first official U.S. federal poverty line was developed in the 1960s; since the mid-1990s the scientific consensus has been that it has become outdated and inaccurate. This article explains the key elements of the current federal measure that are inaccurate for older adults in general and older Latinos specifically. An alternative is described that addresses the key failings of the current measure. The alternative, the Elder Economic Security Standard™ Index (Elder Index), adapts a national methodology to the basic costs of living in California for 2007 using data from the American Community Survey, and other public data sources. The results show that the amount needed for basic economic security in California is higher than the federal poverty level in all counties, and averages about twice the federal level. Housing costs are the largest component of costs in most counties, although health care is the largest component for couples in lower housing cost counties. Among singles and couples age 65 and over in California, almost 60% of Latinos have incomes below the Elder Index compared to one-quarter of non-Latino whites. The rates are higher among renters, and older Latinos are more likely than non-Latino whites to rent. Applying the Elder Index in California documents the disproportionate rates of economic insecurity among older Latinos. The findings indicate that changes to public programs such as Social Security and Medicare that decrease benefits or increase costs will have disproportionately negative impact on the ability of most older Latinos to pay for basic needs.

The Federal Poverty Level does not meet data needs of the California legislature.

This policy brief highlights results from a survey of a broad sample of the California legislature on their data and information needs, as well as their familiarity and use of various economic measures. It finds that legislative staff most often use the Federal Poverty Level (FPL) when they are making recommendations about policy and evaluating programs for low-income populations. Yet the FPL does not meet most of the criteria for economic data that legislative staff say they want. Specifically, the FPL does not measure local conditions, it is not based on current costs, and it does not take into account all types of expenses faced by low-income families. Other measures of economic security more accurately meet legislative staffs' stated data and information needs, including the Elder and Family Economic Security Indices, the U.S. Census Supplemental Poverty Measure and Relative Poverty Measures. Improving awareness and usability of these other measures of economic security can better match the data and information needs of the California legislature and can contribute to innovative solutions to help California's most vulnerable populations.

Older adults need twice the federal poverty level to make ends meet in California.

New calculations using the Elder Economic Security Standard (TM) Index (Elder Index) for California show that both singles and couples age 65 or older who rent need more than twice the amount established by the Federal Poverty Level (FPL) Guideline to meet basic living expenses. The gap is greater for elders who own their home and are paying a mortgage than for renters. The gap between basic expenses and the FPL is smaller for owners without a mortgage, but still exists. Housing and health care are the primary drivers of the high costs. This policy brief documents that the Elder Index provides a better measure of income adequacy than the FPL for older adults because it accounts for those costs at the county level. The growing number of public and nonprofit organizations using the Elder Index will aid the quality of planning and programs that improve income security for California's rapidly growing older population.