Associations between outpatient treatment and the use of intensive psychiatric healthcare services

Clin Child Psychol Psychiatry. 2023 Oct;28(4):1380-1392. doi: 10.1177/13591045231154106. Epub 2023 Feb 3.


The current manuscript examines concurrent and longitudinal associations between the utilization of outpatient and intensive psychiatric services among Medicaid-enrolled youth. Using an administrative dataset of Medicaid claims from 2007 to 2017, youth were included if they were between the ages of 10-18 (M = 13.4, SD = 2.6) and had a psychiatric Medicaid claim (N = 33,590). Psychiatric services were coded as outpatient, emergency department (ED), inpatient, or residential based on Medicaid codes. Logistic regression analyses indicated that the receipt of even one outpatient visit significantly reduced the odds of having an ED, inpatient, and residential visit within 60-, 90-, and 120-day windows. Survival analyses indicated most youth did not have any ED, inpatient, or residential visit following their first outpatient visit. For remaining youth, having an outpatient visit significantly increased the risk of having an ED, inpatient, and residential visit following their initial appointment, which may suggest these youth are being triaged to a more appropriate level of care. Classification accuracy analyses indicated a cutoff of 2 outpatient visits yielded maximum accuracy in determining youth with ED, inpatient, and residential visits. Findings highlight use of outpatient-level services in reducing risk of more intensive service utilization.

Keywords: Medicaid; adolescent; inpatient, psychotherapy; mental health services; outpatient; service use.

MeSH terms

  • Adolescent
  • Ambulatory Care*
  • Child
  • Delivery of Health Care
  • Emergency Service, Hospital
  • Humans
  • Medicaid
  • Outpatients*
  • United States