title: Predictors of adequate depression treatment among Medicaid-enrolled youth.
abstract: OBJECTIVE
  To determine if Medicaid-enrolled youth with depressive symptoms receive adequate acute treatment, and to identify the characteristics of those receiving inadequate treatment.
  
  
  METHODS
  We used administrative claims data from a Medicaid-enrolled population in a large urban community to identify youth aged 6-24 years who started a new episode of treatment for a depressive disorder between August 2006 and February 2010. We examined rates and predictors of minimally adequate psychotherapy (four visits in first 12 weeks) and pharmacotherapy (filled antidepressant prescription for 84 of the first 144 days) among youth with a new treatment episode during the study period (n = 930).
  
  
  RESULTS
  Fifty-nine percent of depressed youth received minimally adequate psychotherapy, but 13 % received minimally adequate pharmacotherapy. Youth who began their treatment episode with an inpatient psychiatric stay for depression and racial minorities were significantly less likely to receive minimally adequate pharmacotherapy and significantly more likely to receive inadequate overall treatment.
  
  
  CONCLUSIONS
  While the majority of youth appear to be receiving minimally adequate acute care for depression, a substantial number are not. Given current child mental health workforce constraints, efforts to substantially improve the provision of adequate care to depressed youth are likely to require both quality improvement and system redesign efforts.
authors.affiliation: Community Care Behavioral Health Organization, Pittsburgh, USA. stein@rand.org
authors.forename: Bradley D
authors.initials: BD
authors.lastname: Stein
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sorbero
authors.forename: Erin
authors.initials: E
authors.lastname: Dalton
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Ayers
authors.forename: Carrie
authors.initials: C
authors.lastname: Farmer
authors.forename: Jane N
authors.initials: JN
authors.lastname: Kogan
authors.forename: Upasna
authors.initials: U
authors.lastname: Goswami
mesh_terms: D000293:Adolescent; D000928:Antidepressive Agents / Q000191:economics / Q000627:therapeutic use; D002648:Child; D003866:Depressive Disorder / Q000628:therapy*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D011613:Psychotherapy / Q000706:statistics & numerical data / Q000639:trends; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents