title: Mental health service use by children with serious emotional and behavioral disturbance: results from the LAMS study.
abstract: OBJECTIVE
  The study described service utilization among children with emotional and behavioral disorders making a first visit to outpatient mental health clinics in four Midwest cities.
  
  
  METHODS
  Data were from the Longitudinal Assessment of Manic Symptoms study. A total of 707 youths aged six to 12 years 11 months and their parents completed diagnostic assessments; demographic information and mental health service use was self-reported. Analyses examined the relationship of demographic variables, diagnoses, impairment, and comorbidity with type and level of services utilized.
  
  
  RESULTS
  Utilization was multimodal; half the youths had received outpatient and school services during their lifetime. Factors unrelated to need (age, sex, race, and insurance) were associated with service type. Children with a bipolar spectrum disorder had higher use of inpatient services than those with depressive or disruptive disorders and were more likely to currently use two or more services. More than half of youths with bipolar or depressive disorders had lifetime use of both medication and therapy, whereas youths with a disruptive behavior disorder were more likely to have used only therapy. Impairment and comorbidity were not related to service utilization.
  
  
  CONCLUSIONS
  Use of services began at a very young age and occurred in multiple service sectors. Type of service used was related to insurance and race, underscoring the need for ongoing disparities research. Contrary to findings from administrative data analyses, use of medication alone was infrequent. The low rate of use of combination therapy suggests that clinicians and families need to be educated about the effectiveness of multimodal treatment.
authors.affiliation: School of Social Welfare, University of Kansas, Lawrence, KS, USA.
authors.forename: Amy N
authors.initials: AN
authors.lastname: Mendenhall
authors.forename: Christine
authors.initials: C
authors.lastname: Demeter
authors.forename: Robert L
authors.initials: RL
authors.lastname: Findling
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Frazier
authors.forename: Mary A
authors.initials: MA
authors.lastname: Fristad
authors.forename: Eric A
authors.initials: EA
authors.lastname: Youngstrom
authors.forename: L Eugene
authors.initials: LE
authors.lastname: Arnold
authors.forename: Boris
authors.initials: B
authors.lastname: Birmaher
authors.forename: Mary Kay
authors.initials: MK
authors.lastname: Gill
authors.forename: David
authors.initials: D
authors.lastname: Axelson
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kowatch
authors.forename: Sarah McCue
authors.initials: SM
authors.lastname: Horwitz
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care / Q000706:statistics & numerical data; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D015897:Comorbidity; D003299:Cooperative Behavior; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D033183:Interdisciplinary Communication; D008137:Longitudinal Studies; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D015146:Midwestern United States; D010348:Patient Care Team / Q000706:statistics & numerical data; D011613:Psychotherapy; D011619:Psychotropic Drugs / Q000627:therapeutic use; D016896:Treatment Outcome; D014481:United States; D014600:Utilization Review / Q000706:statistics & numerical data
chemical_list: D011619:Psychotropic Drugs