Health care transition utilization and outcomes for youth with mental, behavioral, and developmental disorders - PROJECT SUMMARY/ABSTRACT Adolescents and young adults with mental, behavioral, or developmental disorders (MBDD) experience a peak in risk for poor access to care and adverse mental health outcomes, including suicidality, during the transition from pediatric- to adult-focused care. Despite the clear public health importance of this topic, little research exists regarding how health care transition is associated with high care quality and improved mental health outcomes, a deeper understanding of the scope of disparities in transition and downstream outcomes, and evidence toward the potential role of health policy for improving access to timely health care transition in the United States. This project proposes to provide new evidence using a novel dataset that links restricted use, national data on health care utilization and mental health outcomes, and will be unprecedented both in terms of its coverage and scope. Using this new dataset, we will examine the potential role for state and federal mental health policy in affecting access to health care transition in terms of occurrence, timing, and gaps (Aim 1) using quasi-experimental techniques that take advantage of the staggered implementation of mental health parity laws across states over time and the resulting variation in exposure to these policies. This will be the first evaluation of these policies' impact on health care transition. We will examine the impact of health care transition on receipt of high quality care for the treatment of specific MBDD (e.g., depression), and evaluate the extent to which socioeconomic factors moderate this association, potentially exacerbating disparities (Aim 2). Finally, we will use latent class analysis to ascertain mental health outcome patterns and subsequently identify if and to what extent health care transition is associated with these outcome patterns (e.g., whether later age at transition is associated with worsening mental health); further we also evaluate the extent to which socioeconomic factors moderate this association (Aim 3). For Aims 1 and 3, we will obtain estimates for the overall population with MBDD and for disease subtypes (e.g., depression). The scope and size of our dataset will allow us to generate precise estimates across these subgroups and will provide important new information on when and how to intervene to equitably improve mental health outcomes across this critical stage in the life-course. The analyses proposed under this study will generate new and actionable information for policymakers aiming to better understand and mitigate the impacts of inequalities across the transition from adolescence into adulthood.
