Utilization of Mental Health Services among Urban Youth with Emotional and Behavioral Disorders

项目摘要/摘要 不一致和不完整的心理健康治疗是症状改善的重大障碍 为患有精神障碍的青少年提供康复服务。精神卫生保健的连续性，这涉及到定期 与一致的提供者预约，与治疗依从性、减少住院时间、 更低的成本和更好的健康结果。在没有连续门诊治疗的情况下，年轻人更多 可能会经历行为健康危机，因此可能会使用急诊室(ED) 服务。然而，对于精神健康评估和治疗来说，教育部门往往是一个不适当的场所，以及 与门诊护理相比，提供的服务成本更高，强度更低。理解是否存在连续性 门诊精神卫生保健与精神科急诊服务的使用有关，可通知努力 以改善护理的连续性；这可能会减少非紧急青少年精神科到急症室就诊的次数。 在过去的十年里一直在增加，给医院带来了巨大的负担。 迫切需要研究青少年心理健康护理的连续性。这个项目 建议研究精神卫生服务使用的季节性变化。最近的研究表明， 与青少年精神性ED相关的季节性模式的重要性；确定门诊患者的季节性模式 护理可能有助于解释这些发现，并指明一年中可能进行外展和干预的时间 需要的。我们还建议解决目前缺乏针对#年种族和民族差异的研究。 精神科急诊室的使用和门诊护理的连续性。鉴于那些患有精神疾病的少数族裔青年 与他们的白人同龄人相比，他们获得心理健康服务的可能性更小，研究认为 不同种族和民族之间服务使用模式的差异。了解中国的季节模式 精神科急诊和门诊护理对服务不足的少数族裔特别重要，他们已经很少了 有可能得到适当的治疗。 拟议的研究将检查急诊室和门诊精神卫生保健的模式，并调查 相关的社会人口差异，包括种族/族裔和社会经济地位。我会利用健康 2009-2016年在服务于多元文化的城市社区医疗系统收集的记录(EHR) 人口超过140,000名患者。目标1将通过使用广义线性建模和 路径分析，以研究青少年精神科急诊科就诊在历年和一段时间内的变化。目标 2将通过检查青少年门诊精神卫生保健的连续性如何变化来扩展先前的研究 在整个历年和一段时间内。目标3将解决门诊连续性下降的问题 精神卫生保健与精神科急诊服务的使用率增加有关。在每个目标中， 分析将涉及社会人口统计学差异。

PROJECT SUMMARY/ABSTRACT Inconsistent and incomplete mental health treatment is a significant barrier to symptom improvement and recovery for youth with psychiatric disorders. Continuity of mental health care, which involves regular appointments with consistent providers, is associated with treatment adherence, decreased hospitalization, lower costs, and improved health outcomes. In the absence of continuous outpatient treatment, youth are more likely to experience behavioral health crises and consequently may utilize emergency department (ED) services. However, the ED is often an inadequate setting for mental health assessment and treatment, and services provided are more costly and less intensive than outpatient care. Understanding whether continuity of outpatient mental health care is associated with the use of psychiatric emergency services may inform efforts to improve continuity of care; this may in turn reduce non-urgent youth psychiatric visits to the ED, which have been increasing over the last decade and pose a significant burden for hospitals. There is a critical need for research examining continuity of mental health care in youth. This project proposes to examine seasonal variations in mental health service use. Recent research suggests the importance of seasonal patterns related to youth psychiatric ED; identifying seasonal patterns in outpatient care may help explain these findings and indicate times of year when outreach and intervention may be needed. We also propose to address the lack of current research addressing racial and ethnic disparities in both psychiatric ED use and continuity of outpatient care. Given that minority youth with psychiatric diagnoses are less likely to access mental health services than their White peers, it is crucial that research consider differences in service use patterns between racial and ethnic groups. Understanding seasonal patterns in psychiatric ED and outpatient care is of particular importance for underserved minorities, who are already less likely to receive adequate treatment. The proposed study will examine patterns in ED and outpatient mental health care and investigate related sociodemographic disparities, including race/ethnicity and socioeconomic status. I will utilize health records (EHRs) collected from 2009-2016 at an urban community healthcare system that serves a multicultural population of over 140,000 patients. Aim 1 will replicate prior studies by using generalized linear modeling and path analysis to examine how youth psychiatric ED visits vary throughout the calendar year and over time. Aim 2 will extend previous research by examining how continuity of youth outpatient mental health care varies throughout the calendar year and over time. Aim 3 will address whether decreased continuity of outpatient mental health care is associated with increased utilization of psychiatric ED services. Within each aim, analyses will address sociodemographic differences.