Faculty Bibliography

OBJECTIVE: This study examined barriers facing parents who seek outpatient psychiatric care in a large state system for adolescents with depression. METHODS: A total of 264 outpatient facilities licensed to treat youths in New York were contacted by using a mystery shopper methodology. Callers tracked the number of call attempts, in-person appointments, and other steps required prior to seeing a psychiatrist. RESULTS: Fewer than two-thirds of parents made a psychiatry, therapy, or intake appointment. Of those who did not make an appointment, 19% received no referrals. Most callers made at least two calls and spoke with at least two people before initiating scheduling. Virtually all clinics required at least one intake or therapy appointment before receipt of a psychiatry appointment. Parental burden did not differ by region, urbanicity, clinic type, seasonality (spring or summer), or insurance status. CONCLUSIONS: Families of youths with mental health needs face considerable burden in accessing timely treatment.

BACKGROUND: This study examined how mental health clinic administrators decided whether or not to adopt evidence-based and other innovative practices by exploring their views of implementation barriers and facilitators and operation of these views in assessment of implementation costs and benefits. METHODS: Semi-structured interviews were conducted with 75 agency chief executive officers and program directors of 34 New York State-licensed mental health clinics serving children and adolescents. RESULTS: Three interconnected themes relating to barriers and facilitators were identified, namely costs and benefits associated with adoption, capacity for adoption, and acceptability of new practices. The highest percentage of participants (86.7%) mentioned costs as a barrier, followed by limited capacity (55.9%) and lack of acceptability (52.9%). The highest percentage (82.3%) of participants identified available capacity as a facilitator, followed by acceptability (41.2%) and benefits or limited costs (24.0%). Assessment of costs and benefits exhibited several principles of behavioural economics, including loss aversion, temporal discounting use of heuristics, sensitivity to monetary incentives, decision fatigue, framing, and environmental influences. CONCLUSIONS: The results point to opportunities for using agency leader models to develop strategies to facilitate implementation of evidence-based and innovative practices for children and adolescents.

OBJECTIVE: The study examined state variation in rates of Supplemental Security Income (SSI) determinations, allowances, and receipt of benefits for ten selected child mental disabilities in 2013. METHODS: SSI administrative and U.S. Census Bureau data collected by a multidisciplinary consensus committee convened by the National Academies of Science, Engineering, and Medicine in 2015 were examined. RESULTS: Less than 1% of children in 2013 were recipients of SSI for mental disabilities. Determination rates ranged from 1,441 to 251 per 100,000 low-income children, an almost sixfold difference. Allowance rates varied from 16% to 78%, a fivefold difference. Receipt of benefits ranged from .7% to 5.3%, a sevenfold difference. CONCLUSIONS: Large unexplained discrepancies across states were found in review and receipt of SSI benefits for low-income children with mental disabilities. Inequities that cannot be explained by disability severity or financial need violate the ethos of equitable access to federally entitled services.

OBJECTIVE: Since 1997 pediatric residencies have been required to provide a 4-week block rotation in developmental and behavioral pediatrics (DBP), but it is not known whether this has altered the care and management of children by practicing pediatricians. To compare the self-reported practice patterns of pediatricians who were trained with 4 or more weeks of DBP to the practice patterns of those who were trained for < 4 weeks. METHODS: We used self-reported practices from the American Academy of Pediatrics Periodic Survey #85. Pediatricians were asked whether they never, sometimes or usually inquired about and screened for, and whether they treated/managed/co-managed ADHD, depression, anxiety, behavior problems and learning problems. They were also asked about a series of barriers to care. Analyses were weighted to account for low response rates. RESULTS: Those with more DBP training were significantly more likely to treat/manage/co-manage depression, anxiety, behavior problems and learning problems, but were still doing so less than one third of the time. There were no differences in the care of patients with ADHD or in screening or inquiring about mental health conditions. Those with more training were more likely to perceive somewhat fewer barriers and to report more specific familiarity with some DSM criteria and some treatment modalities. CONCLUSION: Longer training is associated with more treatment, but significant deficits in self-reported practice remain, leaving much room for additional improvement in the training of clinicians in DBP.

To systematically review experimental evidence about animal-assisted therapies (AAT) for children or adolescents with or at risk for mental health conditions, we reviewed all experimental AAT studies published between 2000-2015, and compared studies by animal type, intervention, and outcomes. METHODS: Studies were included if used therapeutically for children and adolescents (