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By Sarah C. Threnhauser

Recently, we’ve seen a lot of focus in the health and human service field on the child mental health treatment gap. This treatment gap is the result of a few factors.

First, there is an increase in prevalence in mental and developmental issues among children and youth. The rate of adolescents who reported experiencing symptoms of major depressive disorder increased by 52% between 2005 and 2017. Among young adults ages 18 to 25, the rate of those reporting symptoms of major depression increased by 63% from 2009 to 2017 (see Adolescents & Young Adults Have 50%+ Increase In Major Depression Symptom Prevalence In A Decade). And between 1997 and 2016, the prevalence of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents increased from 6.1% to 10.2% in the U.S. (see U.S. Prevalence Of Child ADHD Increased From 6% To More Than 10% In A Decade).

Then, there is the access issue. A recent analysis found that 16.5% (7.7 million) of the 46.6 million children in the United States, ranging from ages 6 to 17, have a mental health condition. Of these 7.7 million youth, about 3.81 million (49.4%) have not received treatment or counseling from a mental health professional (see 16% Of U.S. Youth Have A Mental Health Condition). Hawaii (7.6%) had the lowest prevalence of at least one mental health disorder, while Maine had the highest (27.2%). Washington, D.C. had the lowest state-level prevalence of children with a mental health disorder who did not receive treatment (29.5%) and North Carolina had the highest state-level prevalence (72.2%).

And between 1997 and 2016, the prevalence of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents increased from 6.1% to 10.2% in the U.S. (see U.S. Prevalence Of Child ADHD Increased From 6% To More Than 10% In A Decade). We’ve also learned in the last year that about 11.6% of school-aged children in the United States diagnosed with ADHD had unmet treatment need (see 11% Of School-Aged Children With ADHD Had Unmet Treatment Need); and approximately 30.7% of students with ADHD receive no school-based intervention services (see Nearly One-Third Of Students With ADHD Receive No In-School Interventions).

The lack of community-based mental health care may be leading to over utilization of emergency resources. Recent findings presented at the American Academy of Pediatrics National Conference & Exhibition also showed that pediatric emergency department (PED) visits for mental health problems increased by 55.8% between 2012 and 2016—from 50.4 PED visits per 100,000 children in 2012 to 78.5 PED per 100,000 in 2016. The rates of PED visits were significantly higher among black children than non-Hispanic white children (see Pediatric Mental Health Emergency Department Visits Increase From 50.4 To 78.5 Visits Per 100,000 Children).

What has lead to this increase in prevalence? The studies cited above offer different explanations—an increased use of technology; increases in sleep disruptions, which may play a role in mood disorders; an increase in awareness, which may lead to more screenings and diagnoses; and other environmental and other prenatal and perinatal risk factors. At this point in time, most research cannot offer a definitive conclusion.

Paul Neitman

There are some more tangible factors explaining for the treatment gap. My colleague, OPEN MINDS Senior Associate Paul Neitman, offered a few potential explanations. First, there is general lack of awareness and stigma about mental health issues. There are high rates of unaddressed trauma in the lives of children in the juvenile justice and foster care systems. And unaddressed mental health stigma, especially in culturally diverse neighborhoods, leads to parents, caregivers, and communities being less receptive the treatment.

Then, there is a shortage of sufficiently skilled mental health professionals to meet demand throughout the country—these shortages may result in regional disparities and reduced access treatment services, particularly in rural areas and in poorer communities. These shortages are fueled by the limited cultural expertise in culturally diverse neighborhoods among most provider organizations and clinical professionals.

Finally, there are systemic issues. A lack of care coordination throughout the systems of care—school, physical health services, mental health services, social support services—that serves children and their families makes it difficult to develop a treatment plan. There are significant costs associated with providing a full range of services, especially in-low density rural areas or high-risk neighborhoods.

The researchers also came to a group of slightly different opportunities, including renewed state policy efforts that focus on reducing the treatment burden, with a focus on developing child mental health policies, implementing prevention and early intervention strategies for transition-age youth, and reducing disparities for mental health care use. Specifically, for children with ADHD, these consumers may benefit from initiatives that target each consumer’s specific impairments with evidence-based intervention approaches.

What are the opportunities for provider organization’s serving children? The first step in this process is to determine if there are opportunities in your market. While there may be nationwide gaps when it comes to mental health need vs. treatment for children, the picture in your market may be different. As an executive team, your role is to first understand the market need and market attractiveness (i.e., potential for growth, competitors, reimbursement and funding potential, etc.).

The maco-market trends are clear—there is a national need for treatment options in children’s services—so it is time for a market intelligence review of your market. This process has a few key elements:

  • Review state policies and financing: Are there programs targeted at early intervention? How are Medicaid services for children manged and financed? What community-based funding and state program grants are available? Who are the key payers for these services?
  • Monitor and analyze the potential customer base: Who are the children in need of services and what are those services? How many children are in need of services in your area? Where are there gaps in care? What do families and caregivers in your community say that they need?
  • Track current competitors: What organizations are currently delivering services to children in your area? Who are their primary payers? What their current contracts and partnerships? Who are the biggest potential referral sources?
  • Talk to payers and health plans: What are their specific needs in children’s services? Where have they identified gaps in their network?

Once your team understands your local market, then you can explore how your organization can fulfill that need in your community. The answers to these questions will help to point your organization in the right direction when it comes to the new service line development process (see How To Develop A New Service Line: Building A Diversification Strategy & Conducting A Feasibility Analysis). Whether its delivering more school-based services, offering telepsychiatry to reach rural and high-risk communities, enhancing cultural competency training in your current service lines to reach new communities in need, or collaborating with social service agencies to better coordinate care for children in need—the right opportunity will depend on the specific needs of your community.

Want to keep up on all the latest news about the children’s service market? With one click, you can customize the market intelligence that comes to your inbox and receive our monthly market intelligence report on children’s services. Update your email preferences today to receive this monthly report—a summary of all of OPEN MINDS’ coverage of the children’s service market.

And for even more, mark your calendar for October 28 when OPEN MINDS will host The 2019 OPEN MINDS Children’s Services Leadership Summit in Philadelphia, Pennsylvania; led by OPEN MINDS Executive Editor, Marge M. Conner-Levin.


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