Health Care Service Utilization Among Anxious and Nonanxious Youth

Background: Anxiety disorders are the most common mental health problem, impacting 15% to 20% of youth at any given time. Despite high prevalence, little is known about the type of health care services utilized by anxious youth, impeding public health efforts to improve access to and quality of care. To address this need, the current study will directly compare service utilization in a large sample of anxious and nonanxious youth patients enrolled within Mental Health Research Network (MHRN). Methods: Preliminary analyses were conducted using a sample of 17,929 youths (ages 4 to 17 years) from Kaiser Permanente Northwest (KPNW). Anxiety diagnoses were derived from ICD-9 codes and service use from procedure codes during 2013–2014. Analyses were completed using a match-control design, in which anxious youth were matched with their nonanxious peers using sociodemographic indices. Results: Results from the KPNW site showed that anxious youth were significantly more likely to receive care than nonanxious matched controls in pediatrics (odds ratio [OR]: 2.28; P \u3c 0.001), family medicine (OR: 1.36; P \u3c 0.001), emergency departments (OR: 2.23; P \u3c 0.001), and urgent care (OR: 1.66; P \u3c 0.001). Anxious youth also were more likely to receive services in specialty care settings such as outpatient mental health (OR: 17.34; P \u3c 0.001), inpatient mental health (OR: 16.56; P \u3c 0.001), neurology (OR: 3.71; P \u3c 0.001) and cardiology (OR: 2.85; P \u3c 0.001). Overall, anxious youths in this insured sample were high utilizers of services, including increased use of high-cost services. Conclusion: Final analyses will integrate data from an additional three MHRN sites using innovative statistical methods designed to pool and analyze de-identified services data across multiple sites. The present study will be one of the first to examine health services use for a large and diverse sample of anxious youth across several different health care settings and systems. Findings from this study will provide unique and critical information about the availability and type of care currently utilized by anxious youth. Results may be useful in guiding efforts to most efficiently intervene with this widely prevalent and highly impairing condition

An Exploration of Parent-Youth Agreement on Functional Impairment in Adolescents Utilizing Outpatient Mental Health Services

Parent-youth agreement on the youth’s functional impairment may have important implications for mental health service utilization, assessment, therapy goal development, and treatment engagement for adolescents. The present study examines parent-youth agreement on their perceptions of youth functional impairment in a predominantly racial/ethnic minority sample of adolescents utilizing outpatient mental health services. Parent and youth functional impairment ratings were compared, and agreement was estimated in multiple ways. On average, parents indicated higher levels of youth functional impairment compared to youth in their overall scores, and when differences existed between parents and youth at the functioning domain and item level. Although there was similarity in the proportion of parents and youth who reported total impairment above the clinical cut-off, actual agreement between parent-youth pairs was only slight. There appeared to be substantial variation in agreement levels when identifying problems in functional impairment at the domain and item levels, and some areas of strong consensus were identified. These findings highlight the need to consider parent-youth agreement in perceptions of functional impairment and the complexities that may underlie this agreement

Examining English- and Spanish-Speaking Therapist Behaviors in Parent-Child Interaction Therapy.

Parent-child interaction therapy (PCIT) is a best-practice treatment for behavior problems in young children. In PCIT, therapists coach parents during in-vivo interactions to strengthen the parent-child relationship and teach parents effective ways of managing difficult child behaviors. Past research has found that different therapist coaching styles may be associated with faster skill acquisition and improved parent engagement. However, most research examining therapist behaviors has been conducted with English-speaking families, and there is limited research examining therapist behaviors when working with Spanish-speaking clients. In this study, English- and Spanish-speaking therapists' coaching behaviors (e.g., directive versus responsive) were examined, as well as their association with client outcomes, including speed of parental skill acquisition and treatment completion. Results suggested that coaching styles varied significantly between sessions conducted in Spanish versus English. In Spanish sessions, therapists had more total verbalizations than in English sessions and demonstrated higher rates of both total directive and responsive coaching. Responsive coaching was found to predict treatment completion across groups, while directive coaching was not. Directive and responsive coaching were not found to predict the rate of parental skill acquisition. Implications regarding the training of therapists and emphasizing cultural considerations are discussed

The factor structure of effortful control and measurement invariance across ethnicity and sex in a high-risk sample

Measurement invariance of a one-factor model of effortful control (EC) was tested for 853 low-income preschoolers (M age = 4.48 years). Using a teacher-report questionnaire and seven behavioral measures, configural invariance (same factor structure across groups), metric invariance (same pattern of factor loadings across groups), and partial scalar invariance (mostly the same intercepts across groups) were established across ethnicity (European Americans, African Americans and Hispanics) and across sex. These results suggest that the latent construct of EC behaved in a similar way across ethnic groups and sex, and that comparisons of mean levels of EC are valid across sex and probably valid across ethnicity, especially when larger numbers of tasks are used. The findings also support the use of diverse behavioral measures as indicators of a single latent EC construct. © 2009 Springer Science+Business Media, LLC

Health Service Utilization Among Children and Adolescents with Posttraumatic Stress Disorder: A Case-Control Study

OBJECTIVE: Trauma exposure is widely prevalent, with more than 60% of adolescents having experienced at least 1 traumatic event and a third of those at high risk to develop posttraumatic stress disorder (PTSD). Data are scarce and out of date on the services children and adolescents with PTSD receive, impeding efforts to improve care and outcomes. This study examines health service use for a large and diverse sample of children and adolescents with and without a diagnosis of PTSD. METHOD: Using a matched case-control study, we gathered information from 4 large health care systems participating in the Mental Health Research Network. Data from each site\u27s electronic medical records on diagnoses, health care encounters, and demographics were analyzed. Nine hundred fifty-five 4- to 18-year-olds with a diagnosis of PTSD were identified and matched on a 1:5 ratio to 4770 controls. We compared cases with controls on frequency of service use in outpatient primary care, medical specialty care, acute care, and mental health care. We also assessed psychotropic medication use. RESULTS: Children and adolescents diagnosed with PTSD used nearly all physical and mental health service categories at a higher rate than controls. However, one-third of children and adolescents did not receive even 1 outpatient mental health visit (36.86%) during the year-long sampling window. CONCLUSION: Our findings suggest that children and adolescents diagnosed with PTSD may have unmet mental health needs. They are high utilizers of health services overall, but lower utilizers of the sectors that may be most helpful in resolving their symptoms