Abstract
This study examined acute inpatient psychiatric admissions among child Medicaid recipients with a mental health diagnosis in one Midwestern state. The authors used multivariable logistic regression to determine the demographic, clinical, and service factors associated with admissions among 51,233 Medicaid enrolled children 3–17 years old who were identified as having a mental health diagnosis. Compared to available data from other states, the overall acute admission rate was low (2.5 %). Clinical factors were the strongest predictors of hospitalization. Youths with mood, disruptive and psychotic disorder diagnoses were 14.1, 6.2, and 5.8 times more likely than other mental health beneficiaries to experience one or more acute inpatient psychiatric admissions. Other predictors of acute admission included prior hospitalization, receipt of two or more concurrent psychotropic medications, older age, and urban residence. A low rate of acute inpatient admissions may indicate successful delivery of community-based mental health services; conversely, it may suggest underservice to youths with mental health need, particularly those in rural areas. Implications for publicly funded children’s mental health care are discussed.
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Notes
Kansas ranks 15th in land area among U.S. states. Thirty-five of Kansas’ 105 counties have fewer than eight residents per square mile, while the five most populous counties comprise more than one-third of the state’s population of 2,853,118 (U.S. Census Bureau 2010).
In 2009, Kansas had a rate of 8.3 child psychiatrists per 100,000 youth, lower than the national average (8.67) (Akin et al. 2009) citation. Most psychiatrists are located in urban counties, leaving the rural and frontier counties without dedicated service. Large areas of the state, primarily rural and frontier counties, have no child psychiatrists. Reliable information on the distribution of inpatient psychiatric beds was not available at the time of the study. During the study period, the state was in the midst of eliminating state hospital beds and opening other facilities and bed availability was thus in flux.
Detailed findings on ten metrics of psychotropic medication use in Kansas can be found in the study report (http://www.keys.org/kureports/finalreportdrugs.pdf).
According to Henry J. Kaiser Family Foundation data from 2011, among children 0-18 in Kansas, White children comprised 68 % of the population; Black or African American children made up 7 % of the population; 16 % of children were Latino/Hispanic, and 10 % identified as Other, which includes Asian-Americans, Pacific Islanders, American Indians, Aleutians, Eskimos and persons of "Two or More Races" (Kaiser Family Foundation 2011).
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This study was funded through a contract with the Kansas Department of Social and Rehabilitation Services Division of Health Care Policy—Mental Health Services.
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Bryson, S.A., Akin, B.A. Predictors of Admission to Acute Inpatient Psychiatric Care Among Children Enrolled in Medicaid. Adm Policy Ment Health 42, 197–208 (2015). https://doi.org/10.1007/s10488-014-0560-6
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DOI: https://doi.org/10.1007/s10488-014-0560-6