title: Predicting level of mental health care among children served in a delivery system in a rural state.
abstract: The purpose of this study was to establish benchmark data to assist in identifying factors associated with mental health service needs and level of care for children living in a rural state. Clinical and psycho-social needs and strengths were assessed using retrospective chart review for all children and adolescents (n=150) with symptoms or a diagnosis of reactive attachment disorder who presented to a comprehensive treatment facility between January 1997 and December 1999. Logistic regression was used to predict factors associated with inpatient admission (n=15) vs. community-based care (n=135). Significant individual contributors to the prediction of inpatient care were more limited clinical/psycho-social strengths, history of inpatient use and history of sexual abuse. Although 80 percent of children admitted to inpatient care had a history of hospitalization, two-thirds had no history of receiving community-based services and presented to current treatment with a two-year or longer history of symptoms. Approximately two-thirds of children admitted to inpatient care had a history of sexual abuse; however, one-third of these children had no history of mental health service use and presented to current treatment with a two-year or longer history of symptoms. Findings raise concerns about current efforts in public health education, community awareness and health prevention and early intervention programs for children with mental/behavioral health challenges and children and families at risk for abuse and/or neglect living in rural areas.
authors.affiliation: Health Management and Policy, College of Public Health, University of Iowa, Iowa City 52242, USA. rachel-anderson@uiowa.edu
authors.forename: R L
authors.initials: RL
authors.lastname: Anderson
authors.forename: G
authors.initials: G
authors.lastname: Estle
mesh_terms: D000293:Adolescent; D019985:Benchmarking; D002648:Child; D002675:Child, Preschool; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D003710:Demography; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007484:Iowa / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008484:Medicaid; D008507:Medically Underserved Area; D019962:Reactive Attachment Disorder / Q000453:epidemiology* / Q000628:therapy; D012189:Retrospective Studies; D012424:Rural Population / Q000706:statistics & numerical data*