Symposia
Dissemination & Implementation Science
Danielle R. Adams, MSW
PhD Candidate
The University of Chicago, Crown Family School of Social Work
Chicago, Illinois
Danielle R. Adams, MSW
PhD Candidate
The University of Chicago, Crown Family School of Social Work
Chicago, Illinois
Nancy Jacquelyn Perez-Flores, MSW
PhD Student
Washington University, Brown School of Social Work
St. Louis, Missouri
Fatima Mabrouk, MSW
PhD Student
New York University, Silver School of Social Work
New York City, New York
Carolyn Minor, BA
Performer
American Blues Theater
Chicago, Illinois
Background. Less than half of adolescents with a mental health (MH) disorder receive any MH care. Medicaid insures 38% of U.S. youth, making community mental health centers (CMHCs) and Federally Qualified Health Centers (FQHCs) key MH providers for Medicaid-enrolled adolescents. Yet MH access barriers remain, including a shortage of specialty providers, lack of insurance acceptance, long wait times, and—for families of color—discrimination at the point of scheduling. Using a mystery shopper method, this study examines how access to trauma-informed MH services delivered in community-based outpatient health agencies varies by insurance type, the race of the caller, and organizational type.
Methods. Three pseudo mothers (hired voice actresses) called eligible CMHCs and FQHCs (N=229) in Cook County, Illinois, requesting to schedule a MH appointment for their adolescent child who recently witnessed a traumatic event. Women of different races (White, Latina, and Black) called each agency twice (once using a Medicaid script and once using private insurance script in random order) in the Spring and Summer of 2021. All appointments were canceled at the end of the call. We used descriptive statistics to evaluate barriers to MH access, wait time, and the availability of trauma-informed treatment. We ran a generalized linear model to assess the impact of contributing factors on scheduling an appointment.
Results. Only 17% (n=78) of pseudo mothers could schedule an appointment, between both waves of data collection. The primary barriers families experienced when scheduling were capacity/waitlist reasons (n=87) and an administrative requirement to switch their primary care provider into the organization's network (n=71). The average wait time was 12 days, and 38% of agencies reported offering trauma-informed treatment. Insurance and organizational type did not predict MH access, but the caller's race did. The Black and Latina callers were 18% more likely to be denied an appointment than the White caller (p = .019).
Conclusion. Less than one in five pseudo mothers could schedule a MH appointment for their adolescent child. Appointments were denied for administrative and capacity reasons. Insurance type did not predict the ability to schedule an appointment; agencies were just as likely to accept clients enrolled in Medicaid as private insurance. The caller's race did predict access, indicating discrimination may be occurring at the point of scheduling. Results of this study will inform policy and practice recommendations to improve access to care.