Nearly Half of Children on Medicaid Lack Outpatient Follow-up Within a Month After Emergency Care for Mental Health
Timely follow-up in Black children particularly low
Only 56 percent of Medicaid-enrolled children received any outpatient follow-up within 30 days after discharge from the Emergency Department (ED) for a mental health concern, according to a large study published in the journal Pediatrics. Rates of timely follow-up among Black children were particularly low, with 10 percent fewer receiving an outpatient mental health appointment within 30 days compared to white children.
“Our results show the dire need to improve access to outpatient mental health services for children,” said lead author Jennifer Hoffmann, MD, MS, Emergency Medicine physician at Ann & Robert H. Lurie Children’s Hospital of Chicago and Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine. “We especially need to remove barriers to mental health care for Black children. Strategies may include reducing stigma in seeking mental health care, improving diversity in the pediatric mental health workforce, and increasing availability of community and school-based mental health services.”
Follow-up within seven and 30 days of a mental health ED visit for children ages 6 to 17 years was added to the National Child Core Set of quality measures in 2022, and state Medicaid agencies will be mandated to report annual adherence rates starting in 2024.
“This work offers some critical insights into the challenges and inequities in mental healthcare for children and youth. These findings should spur efforts to strengthen systems to support mental health for children and youth and new initiatives to non-Hispanic Black children and youth to effective care,” said Dr. Sarah Hudson Scholle, Vice President for Research & Analysis at the National Committee for Quality Assurance (NCQA). NCQA evaluates evidence to select specific quality measures to be used to assess healthcare quality. Based on NCQA recommendations, the quality measure "follow-up within seven and 30 days after an emergency department visit for mental illness in children" was added to the National Child Core Set of quality measures in 2022.
To examine rates of mental health follow-up, Dr. Hoffmann and colleagues conducted a retrospective study of 28,551 children aged 6-17 years with mental health ED discharges from January 2018 to June 2019 using the IBM Watson MarketScan Medicaid database.
They found that after the initial ED discharge, less than one-third of children had mental health follow-up within seven days and just over half had follow-up within 30 days. Children without prior mental health outpatient care were at highest risk for poor access to follow-up care.
“Clearly we need to do better for children who come to the ED in a mental health crisis. Interventions to link to outpatient mental health care should prioritize follow-up within five days of a mental health ED discharge,” said Dr. Hoffmann, who also is the Children's Research Fund Junior Board Research Scholar. “To improve follow-up after mental health ED visits, we need to focus on children with new diagnoses who have not previously engaged in outpatient mental health care. Future research should assess specific strategies to promote outpatient follow-up, such as care coordination and use of telemedicine.”
Research at Ann & Robert H. Lurie Children’s Hospital of Chicago is conducted through Stanley Manne Children’s Research Institute. The Manne Research Institute is focused on improving child health, transforming pediatric medicine and ensuring healthier futures through the relentless pursuit of knowledge. Lurie Children’s is ranked as one of the nation’s top children’s hospitals by U.S. News & World Report. It is the pediatric training ground for Northwestern University Feinberg School of Medicine. Emergency medicine-focused research at Lurie Children’s is conducted through the Grainger Research Program in Pediatric Emergency Medicine.