Medicaid Funded ADHD Treatment for Children Misses Mark
Synopsis and Key Points:
Enactment of the Patient Protection and Affordable Care Act of 2010 expands Medicare benefits to scores of previously uninsured individuals.
Main DigestThe enactment of the Patient Protection and Affordable Care Act of 2010 expands Medicare benefits to scores of previously uninsured individuals including many of our nation's children.
While access to treatment is laudable, the quality of such treatment is the subject of an article in the December issue of the Journal of the American Academy of Child and Adolescent Psychiatry.
In the article titled "Quality of Care for Childhood Attention-Deficit/Hyperactivity Disorder (ADHD) in a Managed Care Medicaid Program," Dr. Bonnie Zima and colleagues report on the treatment of ADHD in 530 children aged 5 to 11 years receiving ADHD care in primary care or specialty mental health clinics from November 2004 through September 2006 in a large, county-wide, managed care Medicaid program. 1 The investigators used a set of longitudinal analyses drawn from Medicaid service and pharmacy claims data, parent and child interviews, and school records, to characterize the mental health care and clinical outcomes of children across three 6-month time intervals.
The rationale in choosing to evaluate the quality of care among children with ADHD is twofold. First is the fact that ADHD represents one of the most common mental health disorders, affecting 3% to 10% of children in the U.S.; and second, more than one-third of the national healthcare expenditures for child mental disorders are paid for by Medicaid.
Dr. Zima and colleagues found that despite a federal policy that requires medical necessity for Medicaid reimbursement of specialty mental health services, the clinical severity of the children in primary care and community mental health clinics was similar. Nevertheless, treatment varied widely, such that most children in primary care were prescribed stimulant medication but seen only one to two times per year compared to less than one- third of children in specialty mental health programs who had on average five mental health visits per month. The infrequency of follow-up visits in primary care was significant because about one-quarter of the children were prescribed combined psychotropic medication treatment. Across both sectors, more than one-third of children dropped out of care and had unmet need for mental health care, persistence of stimulant medication refills was poor, and clinical outcomes did not differ for those children who remained in care compared to those that received no care.
In the article, the researchers state, "Findings from this study identify several areas for quality improvement for ADHD care within the managed care Medicaid program studied. These areas are alignment of the child's clinical severity with provider type, frequency of follow-up visits, stimulant medication use in specialty mental health, agency data infrastructure to document delivery of evidence-based psychosocial treatments, and stimulant medication refill prescription persistence. The enduring symptoms, impairment, and poor academic achievement of the children who remain in care and those untreated underscores the public health significance of improving the quality of care for publicly insured children with ADHD."
This article is discussed in an editorial by Dr. Mark Olfson in the Journal of the American Academy of Child and Adolescent Psychiatry. 2 Reflecting on the relevance of Dr. Zima and colleagues findings, Dr. Olfson states, "The report by Zima and colleagues adds renewed urgency to the call for reform of Medicaid-financed community care of children with ADHD. Closer clinical monitoring with more frequent follow-up contact may be needed to increase continuity of care. Improvements are also needed in medication management, especially in specialty mental health clinics."
This study was supported by the National Institute of Mental Health (RO1 MH061540, P30 MH068639, and P30 MH082760).
The study is published in the Journal of the American Academy of Child and Adolescent Psychiatry and online at www.jaacap.org.
1. Zima BT, Bussing R, Tang L, Zhang L, Ettner S, Belin TR, Wells KB. Quality of Care for Childhood Attention-Deficit/Hyperactivity Disorder in a Managed Care Medicaid Program. Journal of the American Academy of Child and Adolescent Psychiatry. 2010; 49(12):1225-1237.
2. Olfson M. Evaluating the Quality of Community Care for Attention-Deficit/Hyperactivity Disorder. Journal of the American Academy of Child and Adolescent Psychiatry. 2010; 49(12):1183-1185.
About the Journal of the American Academy of Child and Adolescent Psychiatry -The Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) is the official publication of the American Academy of Child and Adolescent Psychiatry. JAACAP is the leading journal focusing exclusively on today's psychiatric research and treatment of the child and adolescent. Published twelve times per year, each issue is committed to its mission of advancing the science of pediatric mental health and promoting the care of youth and their families.
The Journal's purpose is to advance research, clinical practice, and theory in child and adolescent psychiatry. It is interested in manuscripts from diverse viewpoints, including genetic, epidemiological, neurobiological, cognitive, behavioral, psycho-dynamic, social, cultural, and economic. Studies of diagnostic reliability and validity, psychotherapeutic and psycho-pharmacological treatment efficacy, and mental health services effectiveness are encouraged. The Journal also seeks to promote the well-being of children and families by publishing scholarly papers on such subjects as health policy, legislation, advocacy, culture and society, and service provision as they pertain to the mental health of children and families.
About Elsevier -Elsevier is a world-leading publisher of scientific, technical and medical information products and services. The company works in partnership with the global science and health communities to publish more than 2,000 journals, including the Lancet (www.thelancet.com) and Cell (www.cell.com), and close to 20,000 book titles, including major reference works from Mosby and Saunders. Elsevier's online solutions include ScienceDirect (www.sciencedirect.com), Scopus (www.scopus.com), Reaxys (www.reaxys.com), MD Consult (www.mdconsult.com) and Nursing Consult (www.nursingconsult.com), which enhance the productivity of science and health professionals, and the SciVal suite (www.scival.com) and MEDai's Pinpoint Review (www.medai.com), which help research and health care institutions deliver better outcomes more cost-effectively.
A global business headquartered in Amsterdam, Elsevier (www.elsevier.com) employs 7,000 people worldwide. The company is part of Reed Elsevier Group PLC (www.reedelsevier.com), a world-leading publisher and information provider. The ticker symbols are REN (Euronext Amsterdam), REL (London Stock Exchange), RUK and ENL (New York Stock Exchange).
- 1 - Is ADHD Associated with Lack of Regular Circadian Sleep : European College of Neuropsychopharmacology (2017/09/11)
- 2 - Children with Autism Possibly Over-diagnosed with ADHD : Children's Hospital of Philadelphia (2016/10/29)
- 3 - Teaching ADHD Organizational Skills : Michelle Fattig (2010/02/28)
- 4 - Kids with Autism and ADHD at Higher Risk for Anxiety : GolinHarris DC (2018/03/30)
- 5 - Can Adults Develop ADHD? : Florida International University (2017/10/20)
- 6 - Young Children with ADHD Symptoms Have Reduced Brain Size : GolinHarris DC (2018/03/27)
- 7 - Guidance On Civil Rights of Students with ADHD - U.S. Department of Education : U.S. Department of Education (2016/07/27)
• Disabled World is strictly a news and information website provided for general informational purpose only and does not constitute medical advice. Materials presented are in no way meant to be a substitute for professional medical care by a qualified practitioner, nor should they be construed as such. Any 3rd party offering or advertising on disabled-world.com does not constitute endorsement by Disabled World.
• Please report outdated or inaccurate information to us.