(30 lines) This application is being submitted in response to NOT-MH-18-023 entitled ?Notice of Availability of Administrative Supplements for Advancing Computational Modeling and Data Analytics Relevant to Mental Health.? The PI currently has a funded NIMH R21 project grant entitled ?Racial disparities in pediatric psychiatric emergencies: a health systems approach.? Less than half of the nine million children in the U.S. with a severe mental disorder ultimately receive care. This under-treatment occurs more among African American than among white children. Alarmingly, when they do receive psychiatric care, African American children appear in the emergency department (ED) 11% more than do whites. Research examining prevention of suicide remains an NIMH priority. Suicide among youth aged 10-24 years ranks as the third leading cause of death in the US. In addition, ED visits for suicide ideation and self-harm rose an alarming 38% from 2006 to 2011 for youth. Despite this rise in children's suicide-related ED visits, no research examines whether ?supply side? expansions over time in mental health services reduces suicide-related ED visits and/or the risk of suicide death. Federally Qualified Health Centers (FQHCs) represent one dynamic aspect of the health system that focus on low-income populations and now serve 21.7 million Americans. The rapid expansion of primary care in FQHCs may promote continuity of care especially among minority populations and reduce African American children's risk of suicide-related ED visits and/or suicide death. Our project will link suicide mortality to FQHC and suicide-related ED data to examine whether more effective primary mental health care at FQHCs, and relatively fewer ED visits for suicide ideation, self- harm, or depression, precede reductions in the risk of suicide death. We will retrieve suicide cause-of- death data from the US Compressed Mortality File. To this file we will link county-level data (e.g., minority children served in FQHCs) from the Uniform Data System and other proprietary sources. Data on children's suicide-related ED visits will come from the Health Care Utilization Project. The large dataset (~700,000 visits) collected across >150 counties and four years (2012-2015) provides substantial place and time variation in FQHC penetration. We apply under the Administrative Supplement given that we intend to purchase additional years of psychiatric ED data (2012-2015) and also link, at the county level, FQHC and ED data to death records of suicide for the years 2006-2015. This research objective, which aims to evaluate the community program of FQHC expansion, falls directly under the stated NOT-MH-18-023 criterion to promote data linkage of large data sets to ?examine the down-stream impact of community- based interventions.? An examination of whether FQHCs reduce suicide-related ED care and/or mortality among youth?and in racial disparities of such care?will assist policymakers in determining the effectiveness of these public investments.
(Relevance to Public Health 3 sentences) The proposed data supplement directly tests whether expansions in federally qualified health centers reduce suicide-related ED visits as well as suicide mortality among children and young adults (<25 years). Our project may ultimately assist in targeting health policy interventions at the systems level to reduce ED overcrowding by augmenting primary care options. In addition, results will hold direct policy implications in determining the extent to which the $11 billion in annual investments in federally qualified health centers, from a disparities reduction perspective, is justified.
