Assessing and Addressing the Need for Child Psychiatry in NYS

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

5. Background and Significance:Significant gap between prevalence of children with mental disorders and availability of CAPS • 12 - 20% 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 * Representing 9-17 year olds

6. 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 AMA 2006 data

7. Background and Significance:Child and Adolescent Psychiatry – Status of WorkforceCont. • 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) 591-8615 lkaye@uamail.albany.edu