Health Care Services Utilization by Transgender Patients in a Medicaid Managed Program.

While challenges related to health care utilization among transgender individuals have been discussed, studies examining health services under Medicaid are limited. A retrospective review was performed on all patients who presented with Gender Dysphoria from 2013-2018 to one Medicaid managed program. Utilization rates of distinct services and interventions were analyzed. A total of 192 patients, with 787 encounters, were identified. Mean patient age was 15 years old. Mean number of encounters per patient was 4.1. The average number of distinct specialties seen was 1.4. Behavioral health (BH) services were most commonly utilized (50%). Endocrinology and surgical services were encountered less frequently. Medications were prescribed for 25% of patients; hormonal treatment was prescribed for 6.7%. This study highlights the deficiencies in services this population is receiving under one managed Medicaid program. While behavioral health services are widely employed, underutilization of medical and surgical consultations compromises patient awareness of available interventions.

Behavioral health service utilization: Trends in utilization within a patient-centered medical home for low-income children and women.

BACKGROUND: Behavioral health (BH) problems frequently present in primary care settings. Despite high intervention needs, the majority of low-income, racially/ethnically diverse children and women do not receive necessary care. The current study examined utilization of BH care among low-income, racially/ethnically diverse pediatric and obstetric patients receiving services in an integrated patient-centered medical home (the Center) compared to patients receiving services in traditional settings. METHODS: A retrospective review was performed on all consecutive Texas Children's Health Plan (TCHP) patients who received outpatient BH services between 2015 and 2017. Children and woman who utilized BH services at the Center were compared against those who utilized BH services via a traditional sitting outside the Center. RESULTS: A total of 54,612 were identified. Of those, 3,559 (6.5%) patients were seen at the Center and 51,053 (93.5%) patients were seen in the traditional setting. A larger proportion of pregnant/postpartum women and African American and Hispanic/Latino children and women utilized BH services in the PCMH compared to the traditional setting. Results also indicated higher levels of BH service use for patients with behavior problems or anxiety disorders, and increased use of services provided by doctoral level psychologists in the PCMH. CONCLUSION: Findings support the benefit of integrated BH services in PCMH models for engaging traditionally marginalized populations in BH care.

Treatment effectiveness of a brief behavioral intervention for preschool disruptive behavior.

Parent management training is an evidence-based treatment for disruptive behavior. However, the number of treatment sessions can be high, contributing to high attrition rates. The purpose of this study was to examine post-treatment, 6-month, and 1-year treatment outcomes of the Brief Behavioral Intervention. One hundred twenty children aged 2-6.5 years demonstrating clinically significant disruptive behavior were referred to an outpatient clinic for treatment and participated in the study. Attrition was below reported rates in the literature. Significant decreases in child disruptive behavior and parent stress were found from pre-to-post intervention, and improvements were maintained at follow-ups. Significant pre-to-post intervention teacher reported decreases in behavior were reported.