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Objective: Many parents struggle to find mental health care for their children, and many mental health clinicians do not accept insurance payments. The authors aimed to estimate the frequency and cost of self-pay psychotherapy and psychotropic medication management visits for youths and to determine how service use varies by family income. Methods: A descriptive cross-sectional analysis was performed among youths ages 5–17 years in the 2018–2020 Medical Expenditure Panel Survey. Specialist visits included those with psychiatrists, psychologists, social workers, and mental health counselors or family therapists. Results: Approximately one in five of 13,639 outpatient mental health specialist visits were self-pay, with psychologists (23% of visits) and social workers (24% of visits) most likely to see youths on a self-pay basis. Use of self-pay care was strongly associated with higher income, but even families earning <$28,000 per year utilized some self-pay care, at a median cost of $95 per visit. Self-pay visits were associated with slightly lower clinical need than insurance-covered visits, although this measure varied by income. Conclusions: The self-pay market for child mental health care potentially exacerbates inequities in access to care by burdening low-income families with high costs. Incentivizing mental health providers to participate in insurance for larger portions of their patient panels, for example, by increasing reimbursement rates and reducing paperwork, may help improve equitable access to mental health care. To the extent that reimbursement rates drive insurance acceptance, the frequency of self-pay mental health visits suggests that mental health services are underreimbursed relative to their benefit to patients and families. [ABSTRACT FROM AUTHOR]

As value-based care continues to expand, more children with autism spectrum disorder (ASD) will be treated by accountable care organizations (ACOs), provider organizations seeking to improve population health while reducing costs. To inform ACO strategies for children with ASD, this study compared health care expenditures of children insured by a Medicaid managed care organization, empaneled to a safety net ACO, with ASD, asthma, and neither diagnosis. Compared to other study groups, children with ASD were more costly, had lower rates of acute care, and had higher rates of "leaked" care provided by home- and community-based mental health agencies outside of the ACO. These findings highlight the need for unique value-based strategies for children with ASD in a public sector ACO.

The intersection of social risk and race and ethnicity on mental health care utilization is understudied. This study examined disparities in health care treatment, adjusting for clinical need, among 25,780 Medicare Advantage beneficiaries with a diagnosis of a psychiatric disorder. We assessed contributions to disparities from racial and ethnic differences in the composition and returns of social risk variables. Black and Hispanic beneficiaries had lower rates of mental health outpatient visits than Whites. Assessing composition, Black and Hispanic beneficiaries experienced greater financial, food, and housing insecurity than White beneficiaries, factors associated with greater mental health treatment. Assessing returns, food insecurity was associated with an exacerbation of Hispanic-White disparities. Health care systems need to address the financial, food and housing insecurity of racial and ethnic minority groups with psychiatric disorder. Accounting for racial and ethnic differences in social risk adjustment-based payment reforms has significant implications for provider reimbursement and outcomes. [ABSTRACT FROM AUTHOR]

Background: A mindfulness‐based intervention that reduces comorbid pain, anxiety, and substance use during office‐based opioid treatment (OBOT) could enhance retention and prevent overdose. We conducted a pilot study of the Mindful Recovery OUD Care Continuum (M‐ROCC), a 24‐week trauma‐informed program with a motivationally‐sensitive curriculum. Methods: Patients prescribed buprenorphine (N = 18) enrolled in M‐ROCC. We collected urine toxicology biweekly. At 0, 4, and 24 weeks, participants completed PROMIS‐Pain, PROMIS‐Anxiety, Mindfulness (FFMQ), Experiential Avoidance (BEAQ), Interoceptive Awareness (MAIA), and Self‐Compassion (SCS‐SF) scales. We estimated changes over time using mixed models. Participants completed qualitative interviews at 4 and 24 weeks. Results: Positive urine toxicology decreased over time for cocaine (β = −.266, p =.008) and benzodiazepines (β = −.208, p =.028). M‐ROCC reduced PROMIS‐Pain (Z = −2.29; p =.022), BEAQ (Z = −2.83; p =.0005), and increased FFMQ (Z = 3.51; p <.001), MAIA (Z = 3.40; p =.001), and SCS‐SF (Z = 2.29; p =.022). Participants with co‐morbid anxiety had decreased PROMIS‐Anxiety (Z = −2.53; p =.012). Interviewed participants commonly used mindfulness practices for stress and anxiety (12/12, 100%), and to reduce pain catastrophizing and rumination (7/12, 58%). Conclusion and Scientific Significance: This is the first study to report the effects of a 24‐week mindfulness program during buprenorphine treatment on common comorbidities, including pain interference, anxiety, cocaine, and benzodiazepine use. The findings that M‐ROCC is associated with reduced experiential avoidance, as well as increased interoceptive awareness and self‐compassion, align with proposed mechanisms that are now extended to OUD treatment. Future larger randomized controlled trials are needed before effectiveness can be established and the role of these mechanisms can be confirmed. [ABSTRACT FROM AUTHOR]

Aims: To estimate recent trends in cigarette use and health insurance coverage for United States adults with and without mental health and substance use disorders (MH/SUD). Design: Event study analysis of smoking and insurance coverage trends among US adults with and without MH/SUD using 2008–19 public use data from the National Survey on Drug Use and Health, an annual, cross‐sectional survey. Setting: USA. Participants: A nationally representative sample of non‐institutionalized respondents aged 18–64 years (n = 448 762). Measurements Outcome variables were three measures of recent cigarette use and one measure of past‐year health insurance coverage. We compared outcomes between people with and without MH/SUD (MH disorder: past‐year mental illness, predicted from Kessler‐6 and the World Health Organization–Disability Assessment Schedule impairment scale; SUD: met survey‐based DSM‐IV criteria for past‐year alcohol, cannabis, cocaine or heroin use disorder) and over time. Findings Comparing pooled data from 2008 to 2009 and from 2018 to 2019, current smoking rates of adults with MH/SUD decreased from 37.9 to 27.9% while current smoking rates of adults without MH/SUD decreased from 21.4 to 16.3%, a significant difference in decrease of 4.9 percentage points (pts) [95% confidence interval (CI) = 3.3–6.6 pts]. Daily smoking followed similar patterns (difference in decrease of 3.9 pts (95% CI = 2.3–5.4 pts). Recent smoking abstinence rates for adults with MH/SUD increased from 7.4 to 10.9%, while recent smoking abstinence rates for adults without MH/SUD increased from 9.6 to 12.0%, a difference in increase of 1.0 pts (95% CI = −3.0 to 0.9 pts). In 2018–19, 11% of net reductions in current smoking, 12% of net reductions in daily smoking and 12% of net increases in recent smoking abstinence coincided with greater gains in insurance coverage for adults with MH/SUD compared to those without MH/SUD. Conclusions: Improvements in smoking and abstinence outcomes for US adults with mental health and substance use disorders appear to be associated with increases in health insurance coverage. [ABSTRACT FROM AUTHOR]