Partners in Care for Children

OBJECTIVE(S): Partners in Care for Children (PCC) is a quality of care study for children with Attention Deficit Hyperactivity Disorder (ADHD) in public primary care (PC) and carve-out specialty mental health (SMH) sectors enrolled in a managed care Medicaid program. Using a county-wide sample of children, aged 5-11 years, who are enrolled in a large managed care Medicaid program and have had at least one past year contact with public sector outpatient PC or carve-out SMH services, PCC proposes to meet the following aims:

1) To determine the proportion of children who meet ADHD diagnostic criteria or have a history of past year stimulant medication use among those who are identified as having a disruptive behavior problem in public primary care and specialty mental health care settings, adjusting for confounding parent and child socio-demographic factors. Within this aim, the objectives are:

a) to examine the level of ADHD diagnostic accuracy in public primary care and specialty mental health care settings.
b) to determine the rate of stimulant medication use among children who do not meet ADHD diagnostic criteria in public primary care and specialty mental health care settings.

2) To develop need-adjusted indicators of poor quality of care that are applicable to this study population using the RAND/UCLA appropriateness method, a well established approach that derives criteria from both outcomes evidence tables and judgments from a multi-disciplinary expert panel.

3) To examine the clinical processes, appropriateness of care, and outcomes over time (at 6 & 12 months) of children who meet ADHD diagnostic criteria and are treated in public PC and SMH care settings, adjusting for confounding parent and child factors. Within this aim, the objectives are:

a) to describe the clinical processes (diagnosis, assessment, treatment, follow-up), appropriateness of care, and outcomes at the child, family, environment and system levels in public primary care, specialty mental health care and co-managed care.

b) to identify child, provider and system characteristics that are associated with clinical processes, appropriateness of care and outcomes.

METHODS: We will use both primary and secondary data for the study. We plan to interview a sample of children who accessed public care in LA County in the past year, their parents and teachers. We will also analyze data from school records, primary care records, the Department of Mental Health and other county services, as applicable.

FINDINGS / RESULTS: Data collection is ongoing.

STATUS: Baseline and 6 month follow up interviews have been completed. 12 month follow up interviews currently ongoing.

IMPACT: This study represents an important step toward improving the quality of mental health care for low-income, predominantly minority children enrolled in managed care Medicaid programs. Priority is placed on provider and system characteristics that may be related to poor care, such as coverage status (continuity, plan switching), care sector type and mix (PC, SMH, school, foster care, juvenile justice), provider type (solo vs. clinic, directly operated vs. contracted-out clinic program), clinician characteristics (specialty, continuity), and care management type (solo vs. co-managed). Additionally, PCC would establish a significant academic-community partnership whose shared goal is to improve the care for children with serious emotional and behavioral problems. This project represents a strong collaboration between the UCLA Health Services Research Center and the managed care organizations that administer care for Medicaid enrollees in LA County (LA Care and Health Net), the LA County Departments of Health, Mental Health, and Children and Family Services, the Los Angeles Unified School District, and community-based child advocacy organizations.