ABSTRACT
One in five adolescents in the United States have a mental health (MH) disorder, yet less than half receive any MH care. Given the potential lifelong effects of MH problems in adolescence, it is vital that youth with MH disorders are offered timely access to effective treatment. Safety-net health agencies, such as community mental health centers (CMHCs) and Federally Qualified Health Centers (FQHCs), are key points of access for families with adolescents in need of care, especially those enrolled in Medicaid. However, significant barriers exist which may reduce accessibility, including a paucity of qualified specialty providers, lack of insurance acceptance, onerous paperwork requirements, and long wait times. The overall objective of this mixed-methods study is to identify ways to increase timely access to effective MH services delivered in safety-net health agencies that serve adolescents enrolled in Medicaid. Paper 1 uses survey data to describe the availability and accessibility of outpatient MH services for children and adolescents at safety-net health agencies in Cook County, Illinois, a year after the COVID-19 pandemic began in the United States. Findings reveal that approximately 12% of agencies in the initial sample were closed. Roughly 20% of agencies reported not offering outpatient MH services to adolescents. These findings indicate that online directories are often inaccurate or out-of-date. The median wait time for virtual services was 60 days at CMHCs and 15 days at FQHCs. Paper 2 uses a mystery shopper methodology to assess how access to trauma-informed MH services delivered in safety-net outpatient health agencies varies by insurance status (Medicaid vs. private insurance), the race of the caller (White, Latina, or Black), and organizational type (CMHC vs. FQHC). Data indicate that barriers to access are high as less than 20% of pseudo-mothers could schedule an appointment. The primary reasons for appointment denials were a lack of appointment availability at CMHCs and the implementation of administrative burdens at FQHCs. Insurance type did not predict the ability to schedule an appointment, but the caller's race did predict access, indicating discrimination may occur at the point of scheduling.Paper 3 follows up on the findings from Papers 1 and 2 to help determine the administrative burdens that exist in safety-net health agencies and how they act as barriers to accessing MH services. Findings reveal that FQHCs implement a variety of administrative burdens on prospective clients, such as a requirement to designate their primary care physician into the FQHCs network through their insurance prior to scheduling, and frequently engage in other organizational practices that create burdens on families, such as difficult-navigate phone trees, voicemails that are never responded to, and rude or discriminatory interactions with schedulers. These administrative burdens act as barriers to families accessing care due to the psychological, learning, and compliance costs associated with them. (PsycInfo Database Record (c) 2023 APA, all rights reserved)