Quality Improvement Implementation in Child Mental Health: A 2-State Comparison

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DESCRIPTION (provided by applicant): This project will use pooled Medicaid data from NY and PA to examine the impact of a $34M NYS policy initiative designed to re-engineer the service continuum and improve the quality of MH services for publicly-insured children and adolescents (hereafter called children). The NYS policy initiative, called Achieving the Promise (ATP), seeks to increase the detection and early identification of traditionally underserved children with mental illness across NYS, increase referral to and use of services by children with identified problems, provide evidence-based treatment to identified children, and manage costs. ATP is comprised of two initiatives: (a) Clinic Plus, which includes support for an expansion of reimbursable clinic activities to include community outreach, evidence-based screening, evidence-based assessment, and home-based services and (b) the Evidence-Based Treatment Dissemination Center (EBTDC), which provides training and consultation on evidence-based treatments (EBTs) to therapists working in licensed OMH clinics with children and families. We propose to assess the impact of ATP on service provision and child outcomes in New York State using Medicaid administrative data with a matched Medicaid sample as a control group from the State of Pennsylvania. We have gathered a multidisciplinary team that includes the Commissioner and Deputy Commissioners in NYSOMH, as well as psychologists, psychiatrists, mental health services researchers, and biostatisticians. Our specific aims are: 1) To examine the impact of the enhanced screening activities being conducted under ATP on identification of underserved children (minority youth, younger children and those with internalizing disorders); 2) To examine the impact of EBT clinician training on patterns of service use among children receiving treatment at those clinics; and 3) To examine the impact of both Clinic Plus and EBTDC on the use of inpatient, residential, and intensive community treatment services and on costs. We will employ propensity score models to estimate causal effects adjusted for selection bias due to observed characteristics and apply a longitudinal, hierarchical, design to assess change prior to and following the ATP intervention based on propensity score strata for NY participating clinics, NY non-participating clinics, and PA clinics. Methods include analysis of secondary state Medicaid data and Area Resource File data to assess geographic variation. Because the ATP is a system-wide state policy initiative designed to re-engineer the continuum of services for children, this proposed study has the potential to yield policy-relevant information to other states seeking to restructure their youth mental health system.