Quality Improvement Implementation in Child Mental Health: A 2-State Comparison

儿童心理健康的质量改进实施：两种状态的比较

基本信息

批准号：
7848220
负责人：
KIMBERLY E. HOAGWOOD
金额：
$ 14.6万
依托单位：
NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-06-01 至 2012-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7848220
关键词：
Administrator Adolescent Advocate Area Attention Behavior Disorders Characteristics Child Child Mental Health Clinic Clinic Activity Collaborations Communities Community Outreach Complement Consultations Control Groups Data Data Files Detection Disease Early Diagnosis Early identification Emotional Engineering Evaluation Evidence based treatment Expenditure Family Freedom Goals Health system Improve Access Inpatients Intervention Learning Licensing Link Medicaid Mental Depression Mental Health Mental Health Services Mental disorders Methods Minority Modeling National Institute of Mental Health New York Outcome Pattern Pennsylvania Policies Policy Maker Psychiatrist Psychologist Recording of previous events Reporting Research Research Institute Research Personnel Resources Sampling Schools Scoring Method Screening procedure Selection Bias Services Surgeon System Training Trauma Work Youth base c new cost data sharing design evidence base federal policy geographic difference home based service improved inpatient service meetings multidisciplinary outreach programs response trend

项目摘要

DESCRIPTION (provided by applicant): This project will use pooled Medicaid data from NY and PA to examine the impact of a $34M NYS policy initiative designed to re-engineer the service continuum and improve the quality of MH services for publicly-insured children and adolescents (hereafter called children). The NYS policy initiative, called Achieving the Promise (ATP), seeks to increase the detection and early identification of traditionally underserved children with mental illness across NYS, increase referral to and use of services by children with identified problems, provide evidence-based treatment to identified children, and manage costs. ATP is comprised of two initiatives: (a) Clinic Plus, which includes support for an expansion of reimbursable clinic activities to include community outreach, evidence-based screening, evidence-based assessment, and home-based services and (b) the Evidence-Based Treatment Dissemination Center (EBTDC), which provides training and consultation on evidence-based treatments (EBTs) to therapists working in licensed OMH clinics with children and families. We propose to assess the impact of ATP on service provision and child outcomes in New York State using Medicaid administrative data with a matched Medicaid sample as a control group from the State of Pennsylvania. We have gathered a multidisciplinary team that includes the Commissioner and Deputy Commissioners in NYSOMH, as well as psychologists, psychiatrists, mental health services researchers, and biostatisticians. Our specific aims are: 1) To examine the impact of the enhanced screening activities being conducted under ATP on identification of underserved children (minority youth, younger children and those with internalizing disorders); 2) To examine the impact of EBT clinician training on patterns of service use among children receiving treatment at those clinics; and 3) To examine the impact of both Clinic Plus and EBTDC on the use of inpatient, residential, and intensive community treatment services and on costs. We will employ propensity score models to estimate causal effects adjusted for selection bias due to observed characteristics and apply a longitudinal, hierarchical, design to assess change prior to and following the ATP intervention based on propensity score strata for NY participating clinics, NY non-participating clinics, and PA clinics. Methods include analysis of secondary state Medicaid data and Area Resource File data to assess geographic variation. Because the ATP is a system-wide state policy initiative designed to re-engineer the continuum of services for children, this proposed study has the potential to yield policy-relevant information to other states seeking to restructure their youth mental health system.

描述（由申请人提供）：该项目将使用纽约州和宾夕法尼亚州的医疗补助汇总数据来研究纽约州一项耗资 3400 万美元的政策举措的影响，该政策举措旨在重新设计服务连续体并提高为公共保险儿童和儿童提供的 MH 服务质量。青少年（以下简称儿童）。纽约州的政策倡议名为“实现承诺”(ATP)，旨在加强对纽约州传统上服务不足的精神疾病儿童的发现和早期识别，增加已发现问题的儿童的转介和使用服务，为有问题的儿童提供循证治疗。识别儿童并管理成本。 ATP 由两项举措组成：(a) Clinic Plus，其中包括支持扩大可报销诊所活动，包括社区外展、循证筛查、循证评估和家庭服务；(b) Evidence-基础治疗传播中心 (EBTDC)，为在有执照的 OMH 诊所工作的儿童和家庭治疗师提供循证治疗 (EBT) 的培训和咨询。我们建议使用医疗补助行政数据和来自宾夕法尼亚州的匹配医疗补助样本作为对照组，评估 ATP 对纽约州服务提供和儿童结果的影响。我们聚集了一个多学科团队，其中包括 NYSOMH 的专员和副专员，以及心理学家、精神病学家、心理健康服务研究人员和生物统计学家。我们的具体目标是： 1) 检查 ATP 下开展的强化筛查活动对识别服务不足的儿童（少数民族青少年、年幼的儿童和患有内化障碍的儿童）的影响； 2) 检查EBT的影响对临床医生进行关于在这些诊所接受治疗的儿童的服务使用模式的培训； 3) 研究 Clinic Plus 和 EBTDC 对住院、住院和强化社区治疗服务的使用以及成本的影响。我们将采用倾向评分模型来估计因观察到的特征而根据选择偏差进行调整的因果效应，并应用纵向分层设计来根据纽约参与诊所和纽约非参与诊所的倾向评分分层来评估 ATP 干预之前和之后的变化诊所和 PA 诊所。方法包括分析二级州医疗补助数据和地区资源文件数据以评估地理差异。由于 ATP 是一项全系统的州政策举措，旨在重新设计儿童服务的连续性，因此这项拟议的研究有可能为其他寻求重组青少年心理健康系统的州提供政策相关信息。