Difficulty Obtaining Behavioral Health Services for Children: A National Survey of Multiphysician Practices
https://www.annfammed.org/content/20/1/42
In the United States, behavioral health problems such as depression, anxiety, other mental illness, or substance use disorders are increasing among children, and this trend is expected to extend beyond the COVID-19 pandemic. Primary care practices can deliver high-quality, evidence-based behavioral health care for children if practices establish collaborative relationships with behavioral health professionals (psychiatrists, psychologists, therapists) or formally integrate such experts into their practices.
The research hypothesized that most practices in the United States find it difficult to obtain the behavioral health advice and services needed to care for children with behavioral health disorders and that practices owned by health systems and practices participating in alternative payment models might report less difficulty obtaining this care.
The researchers used the National Survey of Healthcare Organizations and Systems 2017-2018 (46.9% response rate), which sampled multiphysician primary and multispecialty care practices including practices that care for children. They characterized practices’ experience as “difficult” relative to “not at all difficult” using a 4-point ordinal scale. We used mixed-effects generalized linear models to estimate differences comparing system-owned vs independent practices and Medicaid ACO participants vs nonparticipants, adjusting for practice attributes.
Adjusting for practice attributes, the percent experiencing difficulty was similar between system-owned and independent practices but was less for Medicaid ACO participants for medication advice and evidence-based psychotherapy; differences were not significant for family-based treatment.
Most multiphysician practices struggle to obtain advice and services for child behavioral health needs, which are increasing nationally. Future studies should investigate the source of observed associations.