Funded Projects

Mental Health Care Coordination for Transition Aged Youth with Serious Mental Health Conditions

Grantee: Children's Research Institute
Principal Investigator: Lisa Tuchman
Project Number: R40MC29453
Project Date: 04/01/2016

Age group(s)

• Adolescence (12-18 years)
• Young Adulthood (19-25 years)

Targeted/Underserved Population

• African American

Abstract

In the Maternal and Child Health field, there is increasing awareness of modifiable health conditions that appear early in the life course and impact development and wellness throughout the life span. Special opportunities exist in vulnerable populations with serious mental health conditions to better understand what life course events can facilitate attainment of optimal health and development. One such opportunity is making sure youth with SED/SMI receive the mental health services they need. Unfortunately, untreated mental illness among adolescents and young adults is a major public health problem. Particularly concerning is the fact that 80% of youth with SED/SMI are not receiving needed mental health services and unmet mental health needs are even higher among certain populations, including minority youth. Youth with untreated mental health problems face a number of challenges that are exacerbated when left untreated. For example, youth with serious mental illness tend to have more difficulties in school and more involvement with the criminal justice system than their peers. These youth also face more challenges successfully transitioning to adulthood and becoming productive members of society. Untreated mental illness tends to lead to more intensive and costly treatment down the road. There are many barriers to accessing mental health services, including stigma and difficulty navigating a complex mental health system, which contribute to unmet mental health needs. Additionally, youth may be so significantly impaired that expecting them to access mental treatment without some supportive services is unrealistic. In light of these facts, it becomes urgent to implement recommended standards for mental health integration and evaluate their impact on mental health outcomes. The Center for Integrated Health Solutions in a joint HRSA-SAHMSA effort recently released expanded joint principles for behavioral health integration. In this model, coordinated care is defined by primary and behavioral health care provided at different locations in the medical neighborhood, but care is coordinated through enhanced communication across the two disciplines. This report makes available an important standard for establishing integrated mental health care coordination practices within a primary care setting, but also demands careful evaluation. The proposed research will quantify the impact of recommended mental health care coordination practices using a randomized trial design and analysis following the intention-to-treat paradigm. We will do so by comparing aspects of 1) experiences of care, (i.e. satisfaction, stigma, quality of mental health care); 2) efficiency/effectiveness (i.e. care coordination, timing, unmet needs), and 3) Mental health outcomes (i.e. symptoms and functioning, involvement with law enforcement/juvenile justice system; rates of substance use /abuse, service utilization) in a population of 16-22 year-old youth receiving primary care in a DC urban academic adolescent medicine practice, using standardized outcome measures. We will address MCHB Strategic Research Issues #I (Public health service systems and infrastructures at the community, state and/or national levels, as they apply to different MCH populations). By implementing these care coordination practices and recommended medical home-based services within our urban adolescent clinic population, we address MCHB Strategic Research Issue #II (MCH services and systems of care efforts to eliminate disparities to health care access for MCH populations), and #III (Services and systems to assure quality of care for MCH populations) by addressing unmet mental health needs of transition aged youth with SED/SMI.