Family Stress Moderates Emotional and Behavioral Symptoms in a Child Partial Hospital Setting

Yaptangco, Mona; Preddy, Teresa M.; Musella, Katharine; Parade, Stephanie H.; Umaschi, Stephanie; Walters, Anne S.

doi:10.1007/s10826-019-01456-y

Cited by 3 publications

(6 citation statements)

References 32 publications

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“…These findings contrast with previous research comparing telehealth IOP outcomes by insurance type that found disparities in outcomes for adults [10] as well as disparities in in-person IOP outcomes for children [32], youths [28], and young adults [35]. In studies addressing youths and young adults, these different findings may be explained by the handling of dropout as these studies appear to have included all clients who initiated treatment [28,35].…”

Section: Principal Findingscontrasting

confidence: 91%

“…It may be that there are higher dropout levels among clients on public insurance and that the resulting effect on outcomes from a smaller dose of treatment is inadequate for symptom improvement. However, a study of a child partial hospitalization program used a nearly identical methodology including only those who stayed for 2 weeks and completed both intake and discharge assessments, finding greater reductions in depression and emotional symptoms for youths on public insurance [32]. As their study focused on children aged 7 to 13 years, it may be that there are differences in treatment outcomes and disparities between children and young adolescents and the adolescents and young adults in our sample.…”

Section: Principal Findingsmentioning

confidence: 94%

“…In each case, youths with private insurance had significantly greater improvements than youths with public insurance. A study of a transdiagnostic child partial hospitalization program found greater reductions in depression and emotional symptoms among children with private insurance relative to those with public insurance [32]. In the only study identified that collected data from multiple reporters, adolescents in an IOP treating self-harm reported no differences by insurance type, but parents of youths with private insurance reported significantly greater behavior improvement than parents of youths with public insurance [28].…”

Section: Telehealth Iops Clinical Outcomes and Insurance Typementioning

confidence: 99%

“…Telehealth IOPs may address transportation and scheduling barriers that could contribute to engagement, and meta-analyses document that telehealth psychiatric care has equivalent outcomes to those of in-person care [30,31]. However, there is a critical need to investigate potential disparities in engagement and effectiveness by demographic factors [32]. Preliminary research has led to a call for greater attention to treatment disparities by insurance type [9,10,32,33].…”

Section: Overviewmentioning

confidence: 99%

“…However, there is a critical need to investigate potential disparities in engagement and effectiveness by demographic factors [32]. Preliminary research has led to a call for greater attention to treatment disparities by insurance type [9,10,32,33]. Such research is critical for informing equitable care.…”

Section: Overviewmentioning

confidence: 99%

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Mental Health Outcomes for Youths With Public Versus Private Health Insurance Attending a Telehealth Intensive Outpatient Program: Quality Improvement Analysis

Gliske¹,

Berry²,

Ballard

et al. 2022

JMIR Form Res

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Background COVID-19 exacerbated a growing mental health crisis among youths and young adults, worsened by a lack of existing in-person options for high-acuity care. The emergence and growth of remote intensive outpatient programs (IOPs) is a solution to overcome geographic limitations to care. However, it remains unclear whether remote IOPs engender equivalent clinical outcomes among youths with public insurance (eg, Medicaid) versus private insurance (eg, commercial) given the disparities found in previous research on place-based treatment in both clinical and engagement outcomes. Objective This analysis sought to establish, as part of ongoing quality improvement efforts, whether engagement and clinical outcomes among adolescents and young adults attending remote IOP treatment differed between youths with public and those with private insurance. The identification of disparities by payer type was used to inform programmatic decisions within the remote IOP system for which this quality improvement analysis was conducted. Methods Pearson chi-square analyses and independent 2-tailed t tests were used to establish that the 2 groups defined by insurance type were equivalent on clinical outcomes (depression, suicidal ideation, and nonsuicidal self-injury [NSSI]) at intake and compare changes in clinical outcomes. McNemar chi-square analyses and repeated-measure 2-tailed t tests were used to assess changes in clinical outcomes between intake and discharge in the sample overall. In total, 495 clients who attended the remote IOP for youths and young adults in 14 states participated in ≥7 treatment sessions, and completed intake and discharge surveys between July 2021 and April 2022 were included in the analysis. Results Overall, the youths and young adults in the remote IOP attended a median of 91% of their scheduled group sessions (mean 85.9%, SD 16.48%) and reported significantly fewer depressive symptoms at discharge (t447=12.51; P<.001). McNemar chi-square tests of change indicated significant reductions from intake to discharge in suicidal ideation (N=470, χ21=104.4; P<.001), with nearly three-quarters of youths who reported active suicidal ideation at intake (200/468, 42.7%) no longer reporting it at discharge (142/200, 71%), and in NSSI (N=430, χ21=40.7; P<.001), with more than half of youths who reported NSSI at intake (205/428, 47.9%) reporting lower self-harm at discharge (119/205, 58%). No significant differences emerged by insurance type in attendance (median public 89%, median private 92%; P=.10), length of stay (t416=−0.35; P=.73), or reductions in clinical outcomes (depressive symptom severity: t444=−0.87 and P=.38; active suicidal ideation: N=200, χ21=0.6 and P=.49; NSSI frequency: t426=−0.98 and P=.33). Conclusions Our findings suggest that youths and young adults who participated in remote IOP had significant reductions in depression, suicidal ideation, and NSSI. Given access to the same remote high-acuity care, youths and young adults on both public and private insurance engaged in programming at comparable rates and achieved similar improvements in clinical outcomes.

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