title: Access to Psychosocial Services Prior to Starting Antipsychotic Treatment Among Medicaid-Insured Youth.
abstract: OBJECTIVE
  To examine rates and predictors of receiving a psychosocial service before initiating antipsychotic treatment among young people in the Medicaid program.
  
  
  METHODS
  A retrospective new-user cohort study of 8 state Medicaid programs focused on children and adolescents 0 to 20 years, initiating antipsychotic treatment (N = 24,372). The proportion receiving a psychosocial service in the 3 months before initiating antipsychotic treatment was calculated and stratified by socio-demographic and diagnostic characteristics arranged in 9 hierarchical groups, as follows: developmental, psychotic/bipolar, disruptive, attention-deficit/hyperactivity, obsessive-compulsive, stress, major depressive, anxiety, and other disorders.
  
  
  RESULTS
  Less than one-half of youth received a psychosocial service before initiating antipsychotic treatment (48.8%). Compared to younger adolescents (12-17 years) initiating antipsychotic treatment (51.5%), corresponding younger children (0-5 years; 39.2%) and older adolescents (18-20 years; 40.1%), but not older children (6-11 years; 51.5%), were significantly less likely to have received a psychosocial service. In relation to youth diagnosed with psychotic or bipolar disorder (52.7%), those diagnosed with attention-deficit/hyperactivity (43.3%), developmental (41.4%), depressive (46.5%), or anxiety (35.6%) disorder were significantly less likely to have received a psychosocial service during the 3 months before antipsychotic initiation. By contrast, youth diagnosed with stress disorders (61.2%) were significantly more likely than those diagnosed with psychotic or bipolar disorders (52.7%) to have received a psychosocial service before starting an antipsychotic.
  
  
  CONCLUSIONS
  A majority of Medicaid-insured youth initiating antipsychotic treatment have not received a psychosocial service in the preceding 3 months. This service pattern highlights a critical gap in access to psychosocial services.
authors.affiliation: New York University Langone Medical Center, New York, and New York State Office of Mental Health, Albany. Electronic address: Molly.Finnerty@omh.ny.gov.
authors.forename: Molly
authors.initials: M
authors.lastname: Finnerty
authors.affiliation: Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes/Institute for Health, Rutgers University, New Brunswick, NJ.
authors.forename: Sheree
authors.initials: S
authors.lastname: Neese-Todd
authors.affiliation: New York State Office of Mental Health, Albany.
authors.forename: Riti
authors.initials: R
authors.lastname: Pritam
authors.affiliation: New York State Office of Mental Health and School of Public Health, State University of New York at Albany.
authors.forename: Emily
authors.initials: E
authors.lastname: Leckman-Westin
authors.affiliation: Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes/Institute for Health, Rutgers University, New Brunswick, NJ.
authors.forename: Scott
authors.initials: S
authors.lastname: Bilder
authors.affiliation: National Committee for Quality Assurance, Washington, DC.
authors.forename: Sepheen C
authors.initials: SC
authors.lastname: Byron
authors.affiliation: National Committee for Quality Assurance, Washington, DC.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hudson Scholle
authors.affiliation: Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes/Institute for Health, Rutgers University, New Brunswick, NJ.
authors.forename: Stephen
authors.initials: S
authors.lastname: Crystal
authors.affiliation: College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York.
authors.forename: Mark
authors.initials: M
authors.lastname: Olfson
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008484:Medicaid; D001523:Mental Disorders / Q000188:drug therapy*; D008605:Mental Health Services; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D014150:Antipsychotic Agents
keywords: access to care; antipsychotic treatment; children; prescribing practices; psychotherapy