Use of Mental Health and Primary Care Services Among Disadvantaged Young Adults

描述(由申请人提供)：没有得到所需的精神健康治疗是弱势低收入年轻人的一个主要问题。这项为期三年的研究涉及大约11,000名年轻人(年龄在18岁至26岁之间)，他们在2004年至2005年期间参加了医疗补助计划，并被授权延长使用精神健康服务，将全面描述他们在18个月的时间里对住院和门诊精神健康服务的利用、精神药物的使用以及精神健康治疗费用。这项研究将侧重于了解医疗补助保险的连续性(即覆盖范围内没有失效的时期)和获得初级保健服务在实现精神健康治疗方面的特殊作用。一个新的框架可能会澄清保险连续性、获得初级保健服务的机会和成年早期使用精神卫生服务之间的复杂关系，将根据两个具体目标进行审查。首先，我们将研究过去一年医疗补助/SCIP覆盖范围的连续性和其他获得初级保健服务的指标与这些年轻人在6个月、12个月和18个月期间对初级保健服务的使用情况、门诊和住院精神健康服务的使用情况和费用，以及精神药物的使用情况和费用的差异有何关系。我们的第二个目标是描述他们在连续6个月的Medicaid/SCIP注册期间对初级保健服务的利用以及他们对门诊和住院精神健康服务和精神药物的利用与他们随后退出Medicaid/SCIP的可能性之间的关系。实现这些目标所需的数据将被汇编到一个独特的数据库中，该数据库将包含来自医疗补助/芯片信息系统和公共医疗保健系统信息系统的信息。这些数据将使我们能够检查初级保健和精神卫生服务的使用情况，以及一年半期间的治疗费用和取消医疗补助的情况。通过提供有关医疗补助登记模式对向成人导向的医疗保健系统过渡期间易受伤害的年轻人获得心理健康服务的影响的信息，以及通过提供关于退出医疗补助的相关性的信息，我们的研究将为医疗补助计划的政策改革提供信息。

DESCRIPTION (provided by applicant): Not receiving needed mental health treatment is a major problem for vulnerable low-income young adults. This three-year study of approximately 11,000 young adults (ages 18 to 26 years old) who were enrolled in the Medicaid program from 2004 to 2005 and were authorized for extended use of mental health services will provide a comprehensive description of their utilization of inpatient and outpatient mental health services, use of psychotropic medications, and mental health treatment costs over a period of 18-months in length. The study will focus on understanding the particular roles of Medicaid insurance continuity (i.e., periods without lapses in coverage) and access to primary care services in enabling mental health treatment. A new framework that may clarify the complex relationships among insurance continuity, access to primary care services, and use of mental health services during the early years of adulthood will be examined in relation to two specific aims. First, we will examine how Medicaid/SCHIP coverage continuity and other indicators of access to primary care services during the past year are related to differences in these young adults' utilization of primary care services, utilization and costs of outpatient and inpatient mental health services, and utilization and costs of psychotropic medications over the subsequent 6-, 12-, and 18-months. Our second aim is to characterize how their utilization of primary care services and their utilization of outpatient and inpatient mental health services and psychotropic medications during a 6- month period of continuous Medicaid/SCHIP enrollment relate to their subsequent likelihood of disenrollment from Medicaid/SCHIP. Data needed to accomplish these aims will be assembled into a unique database that will contain information from a Medicaid/SCHIP information system and from a public MH system information system. These data will allow us to examine use of primary care and mental health services, as well treatment costs and Medicaid disenrollment over a 1 1/2 year period. By providing information about the impacts of Medicaid enrollment patterns on vulnerable young adults' access to mental health services during the period of transition into adult-oriented healthcare systems, and by providing information about the correlates of disenrollment from Medicaid, our research will inform policy reforms in the Medicaid program.