Molly Finnerty1, Sheree Neese-Todd2, Riti Pritam3, Emily Leckman-Westin4, Scott Bilder2, Sepheen C Byron5, Sarah Hudson Scholle5, Stephen Crystal2, Mark Olfson6. 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.
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.
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