Ethnic Disparities in School‐Based Behavioral Health Service Use for Children With Psychiatric Disorders

Abstract

BACKGROUND We examined racial/ethnic disparities in school-based behavioral health service use for children with psychiatric disorders. METHODS Medicaid claims data were used to compare the behavioral healthcare service use of 23,601 children aged 5–17 years by psychiatric disorder (autism, attention deficit hyperactivity disorder (ADHD), conduct/oppositional defiant disorder, and “other”) and by race/ethnicity (African-American, Hispanic, white, and other). Logistic and generalized linear regression analyses were used. RESULTS Differences in service use by racial/ethnic group were identified within and across diagnostic groups, both for in-school service use and out-of-school service use. For all disorders, Hispanic children had significantly lower use of in-school services than white children. Among children with ADHD, African-American children were less likely to receive in-school services than white children; however, there were no differences in adjusted annual mean Medicaid expenditures for in-school services by race/ethnicity or psychiatric disorders. Statistically significant differences by race/ethnicity were found for out-of-school service use for children with ADHD and other psychiatric disorders. There were significant differences by race/ethnicity in out-of-school service use for each diagnostic group. CONCLUSIONS Differences in the use of school-based behavioral health services by racial and ethnic groups suggest the need for culturally appropriate outreach and tailoring of services to improve service utilization.

Students Seeking Mental Health Services at School‐Based Health Centers: Characteristics and Utilization Patterns

“…We used primary ICD‐9 codes for identifying youths' primary behavioral health diagnosis when seeing the mental health provider. This aligns with other published literature that only looks at primary diagnosis. Using this analysis method, comorbidities such as substance use or multiple diagnoses are not captured.…”

“…Thus, the students in this study represent a very specific subset of depressed youth, as they actively engaged in care with a mental health provider. Few published studies of SBHC code‐specific subsets of mental health ICD‐9 codes and those that do demonstrate that the most frequently reported mental health diagnoses are adjustment disorder, family problems, and ADHD . However, comparison between studies is challenging, due to methodological variation in how codes are categorized.…”

Utilization of Mental Health Services in Educational Setting by Adolescents in the United States

“…Similarly, neither the nature of the contact nor the type of treatment (eg, brief conversation, individual psychotherapy, group therapy session), nor the number of such contacts, is captured in the data. This same limitation is, however, found in other studies of school‐based mental health service use (eg, even a single brief visit with a school counselor during the past 12 months may be counted as a youth receiving school mental health services) . Further, “treatment” in this study includes a variety of outpatient and inpatient treatment services.…”

“…Schools are major institutions in children's lives, providing various services over the course of many hours on a typical weekday . For this reason, schools are considered by many observers to be an appropriate setting for providing mental health services, and school‐wide mental health interventions, as well as individually focused services, have increasingly been provided in schools around the country in recent years . According to 2015 data from the National Survey on Drug Use and Health (NSDUH), approximately 3.2 million adolescents in the United States received mental health services in an educational setting .…”

“…Lyon et al, found that higher parental income is related to higher usage of school mental health services, while according to Langer et al socioeconomic status was not a predictor of either school or outpatient mental health use. Locke et al reported evidence of non‐Hispanic black students with attention‐deficit/hyperactivity disorder (ADHD) being more likely to use in‐school behavioral health services and less likely to use out‐of‐school behavioral health services, compared to their non‐Hispanic white counterparts. Additionally, Hispanic students were less likely to report in‐school mental health services utilization, especially if they come from Spanish‐speaking‐only families .…”