Feasibility of expanding services for very young children in the public mental health setting.

OBJECTIVE: A quality-improvement study evaluated the feasibility of training mental health providers to provide mental health screening and relationship-based intervention to expand services for children 0 to 5 years of age in eight California county mental health systems from November 2002 to June 2003. State-level training was provided to more than 582 participants and county-level training to more than 5425 participants, including ongoing supervision. METHOD: Direct services and use of collateral services were tracked. Psychiatric symptoms were screened with new Mental Health Screening and Risk Assessment tools for 388 children (mean age, 34 months). At intake and after intervention (mean of 22 visits), an index sample (93 children) were further characterized by the Diagnostic Classification for Zero to Three and DSM-IV, and parent-child relationship was characterized by the Diagnostic Classification for Zero to Three Parent-Infant Relationship Global Assessment Scale. Providers reported that 41% of their service time was directed to the parent and child together, 35% to the parent alone, and 24% to the child alone. RESULTS: The 93 index children and 295 children in a clinic reference sample were comparable, supporting generalizability. After intervention, Mental Health Screening and Risk Assessment scores were significantly lower. Global Assessment of Functioning scores improved (effect size, 0.35), as did the relationship (Parent-Infant Relationship Global Assessment Scale effect size, 0.16). CONCLUSION: Training mental health staff to provide treatment to infants and preschool children and families in public mental health settings is feasible and leads to an increase in numbers of children served.

Child sociodemographic characteristics and common psychiatric diagnoses in medicaid encounter data: are they valid?

This study describes the rate that Medicaid encounter data on gender, race/ethnicity, and diagnosis matched information in the medical record, among a statewide sample of Medicaid children who received ongoing care for attention deficit hyperactivity disorder (ADHD), conduct disorder (CD), and major depression (MD) in outpatient specialty mental health clinics in 1998-1999. The match rate for gender was 99%; and for race/ethnicity it was 71.8%, 90.5%, and 89.7% for Caucasian, African American, and Hispanic children, respectively. Misidentified Caucasian children were more likely to be recorded as African American or Hispanic than misidentified minority children to be recorded as Caucasian. Diagnosis match rates were high (ADHD: 98%, CD: 89%, MD: 89%). If the California Department of Mental Health relied solely on Medicaid encounter data, misclassification of African American or Hispanic children as Caucasian could produce an underestimate of their service use.