title: Quality of publicly-funded outpatient specialty mental health care for common childhood psychiatric disorders in California.
abstract: OBJECTIVE
  To describe the documented adherence to quality indicators for the outpatient care of attention-deficit/hyperactivity disorder, conduct disorder, and major depression for children in public mental health clinics and to explore how adherence varies by child and clinic characteristics.
  
  
  METHODS
  A statewide, longitudinal cohort study of 813 children ages 6.0-16.9 years with at least 3 months of outpatient care, drawn from 4,958 patients in 62 mental health clinics in California from August 1, 1998, through May 31, 1999. The main outcome was documented adherence to quality indicators based on scientific evidence and clinical judgment, assessed by explicit medical record review.
  
  
  RESULTS
  Relatively high adherence was recorded for clinical assessment (78%-95%), but documented adherence to quality indicators related to service linkage, parental involvement, use of evidence-based psychosocial treatment, and patient protection were moderate to poor (74.1%-8.0%). For children prescribed psychotropic medication, 28.3% of the records documented monitoring of at least one clinically indicated vital sign or laboratory study. Documented adherence to quality indicators varied little by child demographics or clinic factors.
  
  
  CONCLUSIONS
  Efforts to improve care should be directed broadly across clinics, with documentation of safe practices, particularly for children prescribed psychotropic medication, being of highest priority.
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, CA 90024, USA. bzima@mednet.ucla.edu
authors.forename: Bonnie T
authors.initials: BT
authors.lastname: Zima
authors.forename: Michael S
authors.initials: MS
authors.lastname: Hurlburt
authors.forename: Penny
authors.initials: P
authors.lastname: Knapp
authors.forename: Heather
authors.initials: H
authors.lastname: Ladd
authors.forename: Lingqi
authors.initials: L
authors.lastname: Tang
authors.forename: Naihua
authors.initials: N
authors.lastname: Duan
authors.forename: Peggy
authors.initials: P
authors.lastname: Wallace
authors.forename: Abram
authors.initials: A
authors.lastname: Rosenblatt
authors.forename: John
authors.initials: J
authors.lastname: Landsverk
authors.forename: Kenneth B
authors.initials: KB
authors.lastname: Wells
mesh_terms: D000293:Adolescent; D000296:Adolescent Psychiatry / Q000191:economics / Q000592:standards*; D002140:California; D002648:Child; D002665:Child Psychiatry / Q000191:economics / Q000592:standards*; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000191:economics / Q000592:standards*; D011635:Public Health Administration / Q000191:economics / Q000592:standards*; D019984:Quality Indicators, Health Care