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

描述(由申请人提供)：该项目将使用来自纽约州和宾夕法尼亚州的汇集医疗补助数据来检查纽约市一项3400万美元政策倡议的影响，该倡议旨在重新设计服务连续性并提高为公共保险儿童和青少年(以下称为儿童)提供的医疗保健服务的质量。纽约市的政策倡议名为实现承诺(ATP)，旨在增加全纽约传统上服务不足的精神病儿童的发现和早期识别，增加被发现问题的儿童的转介和使用服务，为被发现的儿童提供循证治疗，并控制成本。ATP由两项举措组成：(A)Clinic Plus，其中包括支持扩大有偿诊所活动，以包括社区外展、循证筛查、循证评估和基于家庭的服务；以及(B)循证治疗传播中心(EBTDC)，向在有执照的OMH诊所工作的有儿童和家庭的治疗师提供循证治疗(EBTS)培训和咨询。我们建议使用宾夕法尼亚州的医疗补助管理数据和匹配的医疗补助样本作为对照组，评估ATP对纽约州服务提供和儿童结局的影响。我们聚集了一个多学科团队，其中包括NYSOMH的专员和副专员，以及心理学家、精神病学家、心理健康服务研究人员和生物统计学家。我们的具体目标是：1)研究在《儿童权利公约》下进行的加强筛查活动对识别服务不足的儿童(少数族裔青年、年幼的儿童和患有内在性障碍的儿童)的影响；2)研究EBT的影响。 对在这些诊所接受治疗的儿童进行关于服务使用模式的临床医生培训；以及3)检查Clinic Plus和EBTDC对住院、住院和强化社区治疗服务的使用和成本的影响。我们将使用倾向评分模型来估计因观察到的特征而产生的选择偏差调整后的因果效应，并应用纵向、分层设计来评估基于倾向评分分层的纽约参与诊所、纽约非参与诊所和PA诊所在ATP干预前后的变化。方法包括分析二级州医疗补助数据和地区资源文件数据，以评估地理变异。由于ATP是一项系统范围的州政策倡议，旨在重新设计儿童服务的连续性，这项拟议的研究有可能向寻求重组其青少年心理健康系统的其他州提供与政策相关的信息。

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.