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Abstract

Objective:

Adolescents with behavioral health disorders (i.e., mental health disorders and substance use) often experience frequent recurrence of symptoms, suggesting a need for an ongoing behavioral health intervention, rather than a single course of treatment. However, little is known about mental health care service use among adolescents over longer periods. The authors examined longitudinal patterns of outpatient behavioral health service utilization in a large sample of adolescents.

Methods:

Medicaid claims for 8,197 adolescents (ages 10.0–13.9 years, mean±SD=11.5±1.2; 61% male) from one Indiana county between 2006 and 2017 were examined, with a focus on outpatient psychotherapy visits. Latent class analysis (LCA) was used to detect clusters of longitudinal patterns of outpatient psychotherapy visits across 5 years, beginning with an adolescent’s first behavioral health visit.

Results:

A five-class LCA model emerged with unique classes of service use based on duration and level of engagement (frequency) of monthly outpatient psychotherapy visits. Most adolescents fell in the nonuse class (38.7% of the sample). Additional classes were defined as late-onset low engagement (17.1%), early-onset high engagement (15.5%), early-onset moderate engagement (16.7%), and continuously high engagement (11.9%). Statistically significant differences were found across the classes in average duration and frequency of involvement (p<0.001), as well as in demographic characteristics (race, age, gender, and ethnicity) and behavioral health diagnoses (p<0.001).

Conclusions:

These findings confirm that adolescents with behavioral health diagnoses do not follow a uniform pattern of psychotherapy utilization. The distinct patterns of service use point toward the need to identify appropriate long-term service recommendations for adolescents.

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Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Pages: 374 - 380
PubMed: 36597697

History

Received: 23 August 2021
Revision received: 23 June 2022
Accepted: 22 July 2022
Published online: 4 January 2023
Published in print: April 01, 2023

Keywords

  1. Outpatient treatment
  2. Utilization patterns and review
  3. Behavioral health disorder
  4. Adolescence

Authors

Details

Allyson L. Dir, Ph.D. [email protected]
Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis.
Casey A. Pederson, Ph.D.
Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis.
Fangqian Ouyang, M.S.
Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis.
Patrick O. Monahan, Ph.D.
Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis.
Katherine Schwartz, J.D., M.P.H.
Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis.
Sarah E. Wiehe, M.D., M.P.H.
Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis.
Matthew C. Aalsma, Ph.D.
Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis.

Notes

Send correspondence to Dr. Dir ([email protected]).

Competing Interests

Dr. Monahan has 1.5% equity ownership in a technology start-up L.L.C. called MyShyft (formerly RestUp). The other authors report no financial relationships with commercial interests.

Funding Information

This study was supported by Agency for Healthcare Research and Quality grants R01-HS-022681 and R01-HS-023318.

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