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

描述（由申请人提供）：不接受所需的心理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对大约11,000名年轻人进行了调查，（年龄18至26岁）谁参加了医疗补助计划，从2004年至2005年，并被授权延长使用精神卫生服务将提供一个全面的描述，他们利用住院和门诊精神卫生服务，使用精神药物，和心理健康治疗费用，为期18个月。该研究将侧重于了解医疗补助保险连续性的特殊作用（即，覆盖范围没有中断的时期）和获得初级保健服务，使精神健康治疗成为可能。一个新的框架，可以澄清保险的连续性，获得初级保健服务，并使用心理健康服务，在成年早期之间的复杂关系，将审查两个具体目标。首先，我们将研究如何医疗补助/SCHIP覆盖的连续性和其他指标获得初级保健服务在过去的一年中是相关的差异，这些年轻人的初级保健服务的利用，门诊和住院精神卫生服务的利用和成本，以及精神药物的利用和成本在随后的6个月，12个月和18个月。我们的第二个目标是描述他们在连续6个月的Medicaid/SCHIP登记期间对初级保健服务的利用以及对门诊和住院精神卫生服务和精神药物的利用与他们随后从Medicaid/SCHIP中退出的可能性之间的关系。实现这些目标所需的数据将被汇集到一个独特的数据库中，该数据库将包含来自医疗补助/SCHIP信息系统和公共MH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心理健康服务的使用，以及治疗费用和医疗补助计划在一年半的时间内取消。通过提供有关医疗补助注册模式对弱势年轻人在过渡到面向成人的医疗保健系统期间获得心理健康服务的影响的信息，并通过提供有关取消医疗补助的相关信息，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.