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Research ArticleOriginal Research

Difficulty Obtaining Behavioral Health Services for Children: A National Survey of Multiphysician Practices

Alyna T. Chien, JoAnna Leyenaar, Marisa Tomaino, Steven Woloshin, Lindsey Leininger, Erin R. Barnett, Jennifer L. McLaren and Ellen Meara
The Annals of Family Medicine January 2022, 20 (1) 42-50; DOI: https://doi.org/10.1370/afm.2759
Alyna T. Chien
1Division of General Pediatrics, Department of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
2Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
MD, MS
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  • For correspondence: alyna.chien@childrens.harvard.edu
JoAnna Leyenaar
3Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
4The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire
MD, PhD, MPH
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Marisa Tomaino
4The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire
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Steven Woloshin
4The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire
5The Lisa Schwartz Foundation for Truth in Medicine, Norwich, Vermont
MD, MS
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Lindsey Leininger
4The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire
PhD
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Erin R. Barnett
4The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire
6Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
PhD
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Jennifer L. McLaren
4The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire
6Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
MD
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Ellen Meara
4The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire
7National Bureau of Economic Research, Cambridge, Massachusetts
8Harvard T.H. Chan School of Public Health, Boston, Massachusetts
PhD
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Abstract

PURPOSE In the United States, primary care practices rely on scarce resources to deliver evidence-based care for children with behavioral health disorders such as depression, anxiety, other mental illness, or substance use disorders. We estimated the proportion of practices that have difficulty accessing these resources and whether practices owned by a health system or participating in Medicaid accountable care organizations (ACOs) report less difficulty.

METHODS This national cross-sectional study examined how difficult it is for practices to obtain pediatric (1) medication advice, (2) evidence-based psychotherapy, and (3) family-based therapy. We used the National Survey of Healthcare Organizations and Systems 2017-2018 (46.9% response rate), which sampled multiphysician primary and multispecialty care practices including 1,410 practices that care for children. We characterized practices’ experience as “difficult” relative to “not at all difficult” using a 4-point ordinal scale. We used mixed-effects generalized linear models to estimate differences comparing system-owned vs independent practices and Medicaid ACO participants vs nonparticipants, adjusting for practice attributes.

RESULTS More than 85% of practices found it difficult to obtain help with evidence-based elements of pediatric behavioral health care. Adjusting for practice attributes, the percent experiencing difficulty was similar between system-owned and independent practices but was less for Medicaid ACO participants for medication advice (81% vs 89%; P = .021) and evidence-based psychotherapy (81% vs 90%; P = .006); differences were not significant for family-based treatment (85% vs 91%; P = .107).

CONCLUSIONS Most multiphysician practices struggle to obtain advice and services for child behavioral health needs, which are increasing nationally. Future studies should investigate the source of observed associations.

Key words:
  • accountable care organizations
  • behavior
  • child
  • psychotherapy
  • therapeutics
  • Medicaid
  • pediatrics
  • primary health care
  • Received for publication December 17, 2020.
  • Revision received May 21, 2021.
  • Accepted for publication June 21, 2021.
  • © 2022 Annals of Family Medicine, Inc.
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The Annals of Family Medicine: 20 (1)
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1 Jan 2022
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Difficulty Obtaining Behavioral Health Services for Children: A National Survey of Multiphysician Practices
Alyna T. Chien, JoAnna Leyenaar, Marisa Tomaino, Steven Woloshin, Lindsey Leininger, Erin R. Barnett, Jennifer L. McLaren, Ellen Meara
The Annals of Family Medicine Jan 2022, 20 (1) 42-50; DOI: 10.1370/afm.2759

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Difficulty Obtaining Behavioral Health Services for Children: A National Survey of Multiphysician Practices
Alyna T. Chien, JoAnna Leyenaar, Marisa Tomaino, Steven Woloshin, Lindsey Leininger, Erin R. Barnett, Jennifer L. McLaren, Ellen Meara
The Annals of Family Medicine Jan 2022, 20 (1) 42-50; DOI: 10.1370/afm.2759
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Subjects

  • Domains of illness & health:
    • Mental health
  • Person groups:
    • Children's health
  • Methods:
    • Quantitative methods
  • Other research types:
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  • Core values of primary care:
    • Access
    • Coordination / integration of care

Keywords

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  • behavior
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  • psychotherapy
  • therapeutics
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