Access to and patterns of use of behavioral health services among children and adolescents in TennCare.
OBJECTIVE
This study assessed trends in access to and use of behavioral health services for school-aged children in TennCare, Tennessee's Medicaid managed care program, between state fiscal years 1995 and 2000.


METHODS
Claims, encounter, and enrollment data from the Bureau of TennCare were used. The data analyzed were restricted to services and enrollment periods for children and adolescents between the ages of four and 17 years at the time of service or enrollment. Measures were calculated in four areas: overall access to behavioral health services, use of inpatient services, use of outpatient specialty treatment services, and use of supportive services like case management and medication management.


RESULTS
The number of youths who received a behavioral service increased by nearly 50 percent between state fiscal years 1995 and 2000. At the same time, the number of youths enrolled in TennCare increased by 19 percent. The annual access rate increased from 72.7 youths per 1000 enrollees to 91.7. However, the volume of services for children fell. Access rates were low relative to estimates of need in this population. The system made less use of inpatient services and relied more on outpatient services, particularly case management and medication management services.


CONCLUSIONS
Children's access rates for behavioral health services improved even as the TennCare program expanded to cover more children. The system served more youths in part by reducing the volume of services for children receiving treatment and substituting more supportive services. Ongoing performance monitoring for policy making will require enhancements of data monitoring activities by the state.
Saunders
Robert C
RC
Department of Human Organization and Development, Vanderbilt University, Nashville, Tennessee 37203, USA. robert.c.saunders@vanderbilt.edu
Heflinger
Craig Anne
CA
D000293:Adolescent; D000553:Ambulatory Care / Q000706:statistics & numerical data / Q000639:trends; D001521:Behavior Therapy / Q000639:trends*; D019090:Case Management / Q000706:statistics & numerical data / Q000639:trends; D002648:Child; D003430:Cross-Sectional Studies; D005544:Forecasting; D006297:Health Services Accessibility / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D008329:Managed Care Programs / Q000706:statistics & numerical data* / Q000639:trends; D008484:Medicaid / Q000706:statistics & numerical data* / Q000639:trends; D001523:Mental Disorders / Q000453:epidemiology* / Q000628:therapy; D008605:Mental Health Services / Q000706:statistics & numerical data* / Q000639:trends; D020380:Needs Assessment / Q000639:trends; D010343:Patient Admission / Q000639:trends; D013221:State Health Plans / Q000706:statistics & numerical data* / Q000639:trends; D013714:Tennessee; D014481:United States; D014600:Utilization Review / Q000706:statistics & numerical data / Q000639:trends