title: Access to Care for Youth in a State Mental Health System: A Simulated Patient Approach.
abstract: To examine access to psychiatric care for adolescents with depression in outpatient specialty clinics within a state mental health system, using a simulated patient approach.
  
  
  
  Trained callers posed as the mother of a 14-year-old girl with depression, following a script. A stratified random sample (n = 264) of 340 state-licensed outpatient mental health clinics that serve youth was selected. Clinics were randomly assigned to season and insurance condition. We examined whether access varied by season, clinic characteristics, and caller insurance type. Weighted logistic and linear mixed effects regression models were fitted to examine associations with appointment availability and wait times.
  
  
  
  Among clinics at which a treatment appointment could be scheduled, appointment availability differed by season. Clinics that had participated in state-sponsored trainings targeting access were more available. Wait times for treatment appointments varied by season and region. Wait times in New York City were shorter than in some other regions. Although callers were 4.1 times more likely to be able to schedule a psychiatry appointment in the spring, wait times for psychiatry appointments were significantly longer in the spring than in the summer (49.9 vs. 36.7 days). Wait times for therapy appointments were significantly shorter in community than in hospital clinics (19.1 days vs. 35.3 days).
  
  
  
  Access to psychiatric care for youth with depression was found to be variable in a state system. State-sponsored trainings on strategies to reduce wait times appear to improve care access. The simulated patient approach has promise for monitoring the impact of health care policy reforms on care quality measures.
authors.affiliation: New York University Langone Medical Center, New York. Electronic address: Serene.Olin@nyumc.org.
authors.forename: Su-Chin Serene
authors.initials: SC
authors.lastname: Olin
authors.affiliation: The Center-Coordinated Care Services, Inc., Rochester, NY.
authors.forename: Briannon C
authors.initials: BC
authors.lastname: O'Connor
authors.affiliation: Statistical Research Consultants LLC, Chicago.
authors.forename: Amy
authors.initials: A
authors.lastname: Storfer-Isser
authors.affiliation: New York State Office of Mental Health, Albany.
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Clark
authors.affiliation: New York State Office of Mental Health, Albany.
authors.forename: Matthew
authors.initials: M
authors.lastname: Perkins
authors.affiliation: National Committee for Quality Assurance, Washington, DC.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hudson Scholle
authors.affiliation: New York University Langone Medical Center, New York.
authors.forename: Emma D
authors.initials: ED
authors.lastname: Whitmyre
authors.affiliation: New York University Langone Medical Center, New York.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Hoagwood
authors.affiliation: New York University Langone Medical Center, New York.
authors.forename: Sarah McCue
authors.initials: SM
authors.lastname: Horwitz
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000592:standards* / Q000706:statistics & numerical data; D000553:Ambulatory Care / Q000592:standards* / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008605:Mental Health Services / Q000592:standards* / Q000706:statistics & numerical data; D016544:Patient Simulation
keywords: access to psychiatric care; appointment availability; outpatient mental health clinics; simulated patient; wait times