As a contribution to the national Multi-Site Study of Mental Health Service Use, Need, Outcomes, and Costs in Child and Adolescent Populations (UNO-CAP), we propose a multi-stage, community-based, eight-county study of use, need, outcomes, and costs of mental health care for children and adolescents aged 4 to 17 in an area representative of the rural southeastern United States. More than 25% of these children live in poverty and 48% are African American. The design includes both a longitudinal, epidemiological survey and a quasi-experimental comparison of outcomes in one area Mental Health Authority providing standard care, and one that is implementing Carolina Alternatives, North Carolina's Medicaid waiver program to test the impact of capitation funding within an organized managed care delivery system. This is a Public Academic Liaison (PAL) with the State.
Specific aims are: (1) To describe service needs in the community.in terms of psychiatric diagnosis, psychosocial impairment, risk factors, and family burden; (2) To describe patterns of service use in and across the mental health, substance abuse, health, school, social welfare, and juvenile justice sectors. The focus is on movement into and among the sectors, emphasizing help-seeking, amount and type of service use, and changes in level of care. Predictive models of service use will be developed in terms of (a) demographics (age, race, urban/rural residence); (b) economics (family income, employment, cost of services); (c) mental health (diagnosis, comorbidity, symptom severity, psychosocial impairment); (d) family burden, psychiatric history, structure, and functioning; and (e) service system factors (availability of and barriers to services, service system integration, cost of services, and financing mechanism, including Carolina Alternatives); (3) To describe the economic impact of child mental health problems on families and the community over time, in terms of parental income, jobmarket involvement, and the costs and financing of services; and (4) To describe service-user's and non- user's outcomes over three waves of annual interviews, in terms of clinical outcomes, """"""""policy relevant outcomes"""""""" (arrests, pregnancies, deaths, school dropout), family burden, functioning, and mental health, family income, and service outcomes (treatment dropout rates, changes in restrictiveness of setting, costs of services). In particular, we will test whether the Medicaid-waiver program, implemented in four counties, improves service availability and other outcomes (a) for Medicaid eligible children, and (b) for the rest of the community. The multi-stage survey design involves a one-time screening of 5,000 randomly selected households, followed by three waves of annual interviews with 2,681 parent-child pairs. Information is also collected from teachers and service settings. The study will use measures selected by the Collaborative Agreement members. Whether used at one UNO-CAP site or across all sites, this design provides maximum generalizability and comparability.
| Angold, Adrian; Erkanli, Alaattin; Farmer, Elizabeth M Z et al. (2002) Psychiatric disorder, impairment, and service use in rural African American and white youth. Arch Gen Psychiatry 59:893-901 |
