title: Behavioral predictors of outpatient mental health service utilization within 6 months after traumatic brain injury in adolescents.
abstract: OBJECTIVE
  To characterize utilization of mental health services and determine the ability of a behavior problem and clinical functioning assessment to predict utilization of such services within the first 6 months after moderate and severe traumatic brain injury in a large cohort of adolescents.
  
  
  METHODS
  Multicenter cross-sectional study.
  
  
  METHODS
  Outpatient setting of 4 tertiary pediatric hospitals, 2 tertiary general medical centers, and 1 specialized children's hospital.
  
  
  METHODS
  Adolescents age 12-17 years (n = 132), 1-6 months after moderate-to-severe traumatic brain injury.
  
  
  METHODS
  Logistic regression was used to determine the association of mental health service utilization with clinical functioning as assessed by the Child and Adolescent Functional Assessment Scale and behavior problems assessed by the Child Behavioral Checklist.
  
  
  METHODS
  Mental health service utilization measured by the Service Assessment for Children and Adolescents.
  
  
  RESULTS
  Behavioral or functional impairment occurred in 37%-56%. Of the total study population, 24.2% reported receiving outpatient mental health services, 8.3% reported receiving school services, and 28.8% reported receiving any type of mental health service. Use of any (school or outpatient) mental health service was associated with borderline to impaired total Child and Adolescent Functional Assessment Scale (odds ratio 3.50 [95% confidence interval, 1.46-8.40]; P < .01) and the Child Behavioral Checklist Total Competence (odds ratio 5.08 [95% confidence interval, 2.02-12.76]; P < .01).
  
  
  CONCLUSIONS
  A large proportion of participants had unmet mental health needs. Both the Child and Adolescent Functional Assessment Scale and the Child Behavioral Checklist identified individuals who would likely benefit from mental health services in outpatient or school settings. Future research should focus on methods to ensure early identification by health care providers of adolescents with traumatic brain injury in need of mental health services.
authors: Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, 3333 Burnet Ave. MLC 4009, Cincinnati, OH 45229-3039(∗). Electronic address: brad.kurowski@cchmc.org.
authors: Brad G
authors: BG
authors: Kurowski
authors: Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH(†).
authors: Shari L
authors: SL
authors: Wade
authors: Department of Physical Medicine and Rehabilitation, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO(‡).
authors: Michael W
authors: MW
authors: Kirkwood
authors: Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN(§).
authors: Tanya M
authors: TM
authors: Brown
authors: Division of Pediatric Psychology, Department of Psychiatry, MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH(¶).
authors: Terry
authors: T
authors: Stancin
authors: Division of Developmental and Behavioral Pediatrics and Psychology, Department of Pediatrics, Case Western Reserve University and Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, OH(‖).
authors: H Gerry
authors: HG
authors: Taylor
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000367:Age Factors; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001930:Brain Injuries / Q000523:psychology* / Q000534:rehabilitation*; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D012307:Risk Factors; D013997:Time Factors
references: J Head Trauma Rehabil. 2014 May-Jun;29(3):198-207
references: 23640543
references: J Am Acad Child Adolesc Psychiatry. 1997 Sep;36(9):1278-85
references: 9291730
references: J Am Acad Child Adolesc Psychiatry. 2000 Aug;39(8):1032-9
references: 10939232
references: J Am Acad Child Adolesc Psychiatry. 1998 Aug;37(8):832-40
references: 9695445
references: J Behav Health Serv Res. 1998 Aug;25(3):325-36
references: 9685751
references: Psychiatr Serv. 2011 Mar;62(3):264-71
references: 21363897
references: Lancet. 1974 Jul 13;2(7872):81-4
references: 4136544
references: Child Care Health Dev. 2011 May;37(3):418-21
references: 21276036
references: J Neuropsychiatry Clin Neurosci. 1998 Summer;10(3):290-7
references: 9706536
references: J Pediatr Psychol. 2003 Jun;28(4):251-63
references: 12730282
references: Psychiatr Serv. 2001 Aug;52(8):1088-94
references: 11474056
references: West J Med. 1999 Jan;170(1):28-34
references: 9926733
references: Am J Orthopsychiatry. 2006 Jul;76(3):312-24
references: 16981810
references: J Rehabil Med. 2009 Feb;41(3):179-86
references: 19229452
references: Md Med J. 1989 Mar;38(3):239-45
references: 2927267
references: J Head Trauma Rehabil. 2009 Sep-Oct;24(5):303-12
references: 19858964
references: J Neurotrauma. 2012 Mar 1;29(4):678-705
references: 21644810
references: Adm Policy Ment Health. 2009 Nov;36(6):361-73
references: 19641987
references: Ethn Health. 2012;17(1-2):105-10
references: 22236053
references: J Am Acad Child Adolesc Psychiatry. 1997 Jan;36(1):94-102
references: 9000786
references: Brain Inj. 2000 May;14(5):417-29
references: 10834337
references: J Policy Anal Manage. 2010 Fall;29(4):698-725
references: 20964104
references: J Nerv Ment Dis. 1997 Jun;185(6):394-401
references: 9205426
references: Psychiatr Serv. 2007 Mar;58(3):357-64
references: 17325109
references: J Health Care Poor Underserved. 2008 Feb;19(1):237-47
references: 18263999
references: J Head Trauma Rehabil. 2013 Sep-Oct;28(5):E1-12
references: 22935574
references: Pediatrics. 2006 Apr;117(4):e663-74
references: 16533894
references: J Neuropsychiatry Clin Neurosci. 2012 Fall;24(4):427-36
references: 23224448
references: Arch Phys Med Rehabil. 2013 Mar;94(3):543-50
references: 23131527