1 Assessing and Addressing the Need for Child Psychiatry in NYS Center for Human Services Research and Conference of Local Mental Hygiene Directors

2 Introduction  Objectives of the study  Project activities  Background and significance of CAPs shortage  Study design  Questionnaire design  Evaluation and next steps

3 Study Objectives  Describe  Current status of child psychiatrists in each county  Need for children’s mental health services in each county  Identify  Exemplary models of alternative strategies (for e.g. telepsychiatry, systems collaboration)  Unique characteristics that influence the delivery of children’s mental health services

4 Project activities  Secondary data analyses on children’s mental health service needs  Convene and consult with an advisory group  Consult with the experts in the field  Review relevant literature, reports, and documents  Develop a questionnaire for survey of NYS counties  Administer the survey, collect and analyze the data, and report the findings

* Representing 9-17 year olds5 Background and Significance: Significant gap between prevalence of children with mental disorders and availability of CAPS  % of children suffer from mental health problems  9 – 13% of children experience serious emotional disturbances (SED)*  5 – 10% of children suffer extreme/severe functional impairment* (Kim, 2003) Using Census 2000 data, the above figures could translate for NYS children 9 to 17 years old:  250,001 – 416,668 children with mental health problems  187,501 – 270,834 children with SED  104,167 – 208,334 suffer extreme/severe functional impairment

AMA 2006 data6 Background and Significance: Child and Adolescent Psychiatry – Status of Workforce  One third of NYS’s counties do not have any CAPs  Close to 90% of the all the CAPs in NYS are in eleven counties

7 Background and Significance: Child and Adolescent Psychiatry – Status of Workforce Cont.  Significantly more child and adolescent psychiatrists are located in:  Metropolitan counties  Counties with low % of children living in poverty (Thomas and Holzer III, 1999)  These findings appear to be true in NYS  Rural counties in NYS suffer disproportionate CAP Shortages

8 Background and Significance: Disparities  79% of children 6-17yrs who are in need of mental health services do not receive them  Unmet need is greatest for Hispanic children (88%) and the uninsured (87%) (Kataoka, Zang, & Wells, 2002)  African American children/adolescents were significantly less likely to receive treatment than White and Hispanic.  Uninsured were also less likely to receive treatment than those with public or private insurance. (Olfson, Gameroff, Marcus, and Waslick, 2003)

9 Study Design  Telephone survey administered to mental health directors in  57 counties  and NYC (5 boroughs)  County level demographic and mental health service information will be obtained from various sources including census data, OMH, AMA, OASIS, & USDA

10 Questionnaire Design  The questionnaire is a result of  Thorough literature review  Consultation with OMH, AACAP, Center for Health Workforces Studies at the school of public health, Research Unit at HRDP/University of Montreal, and the Urban Institute Health Policy Center.  Review and feedback from our Advisory Committee Members  Pre-testing of the instrument  It has has five sections:  Current status  Need  Alternative strategies  Influence on child psychiatric services  Respondent priorities

11 Current status and need  Section One: Current Status  Current status of CAPs  Demographic, workforce, service setting  Current status of psychiatric services  Coordination of care, policy, budget, barriers  Section Two: Need  How many CAPs  For which populations and in which settings  Psychiatric services  Waits, services outside county, need for more services

12 Alternative Strategies  Other professional groups in addition to or instead of CAPs  Strategies, practitioners or trainings used to address CAP shortages  Telepsychiatry  Implementaion and use  Fundings and expenses  Who receives services  Benefits and drawbacks

13 Influences on Child Psychiatric Services and Respondents’ Priorities  Influences  Events that directly impact (e.g. lawsuits, accidents)  Those that indirectly impact (e.g. business closing, crisis event)  Trends or changes  in consumers, that impact availability of CAPs  Respondent  Priorities and recommendations

14 Evaluation  Analysis will compare counties based on  A rural-urban continuum  Being centrally located (geographically and to service provisions)  Proximity to major metropolitan regions  Percentage of families living in poverty

15 Next Steps  Interviews will take place this fall  Data analysis and write up will take place this winter  Final report including aggregate and individual county level data will be available in 2008  Results of considerable interest  Nationally, in NYS and at the county level  Findings may have policy implications

16 Thank you! For further information contact: Lara Kaye, Center for Human Services Research (518)