OBJECTIVE(S): To describe psychosocial and medication treatment patterns among children and adolescents with probable attention-deficit hyperactivity disorder (ADHD), conduct disorder (CD), and major depressive disorder (MDD) in California's outpatient publicly-funded child mental health clinics. To also explore how documented guideline concordant care varies by child socio-demographic and clinic characteristics.

METHODS: Using a computerized medical record abstraction tool, psychosocial and medication treatment patterns for children receiving care for probable ADHD, CD and MD were assessed among a statewide sample of 813 children ages 6.0-16.9 years with at least 3 months of outpatient care, drawn from a 4,958 patients in 62 mental health clinics in California from August 1, 1998 through May 31, 1999. Acceptable care was defined for ADHD as any stimulant and/or any behavioral treatment, for MD any antidepressant and/or individual therapy, and for CD any behavioral treatment. Multivariate regression was conducted to explore independent predictors of acceptable care, using weighted data.

FINDINGS / RESULTS: Overall, 83% of children received any psychosocial treatment, 57.6% of children received any psychotropic medication treatment, and 42% received any case management. Boys, children from Caucasian backgrounds, and those with ADHD were more likely to receive psychotropic medication treatment. Girls, African - Americans, Latinos, and those with CD were less likely to receive psychotropic medication treatment. Of those with MD, 84% received any psychosocial treatment and of these slightly less than one half (47%) also received medication. Few children with CD received behavior therapy. Remarkably, almost three-fourths of children (73%) received individual psychotherapy and use did not vary by disorder. Use of case management did not vary by psychosocial complexity. Acceptable care was documented for 59.6% of children with ADHD, 3.2% with CD, and 86.3% with MDD. For ADHD, children from Latino backgrounds and those with high psychosocial complexity were more likely to receive unacceptable care. For MD, adolescents and children from Native American and Asian American backgrounds were more likely to receive acceptable care. Conclusion

STATUS: The data has been presented at the 2006 American Psychiatric Association Annual Meeting in Toronto and has been accepted as a presentation at the 2006 American Academy of Child and Adolescent Psychiatry Annual Meeting in San Diego in October. A manuscript is currently being prepared based on these analyses for submission to an academic medical journal.

IMPACT: This project shows that it is feasible to assess the quality of care for common childhood mental health disorders. In addition, this study shows that it is also feasible to use observational data to understand how treatment providers treat children in 'real world" treatment settings.

Principal Investigator:
Bonnie Zima, MD, MPH; Bowen Chung, MD (Fellow)

Sponsored by:
State of California Department of Mental Health