Psychopathology as a Predictor of Medical Service Utilization for Youth in Residential Treatment
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dress correspondence to Timothy D. Nelson, PhD, Department of Psychology, University of Nebraska–Lincoln, 319 Burnett Hall, Lincoln, NE 6858 8-0308, USA. Phone: +1-402-4727707; Fax: +1-402-4724637; Email: [email protected]. Tori R. Smith, BS, Department of Psychology, University of Nebraska–Lincoln, Lincoln, NE, USA. Robert Pick, MS, Boys Town Nebraska/Iowa Region, Boys Town, NE, USA. Michael H. Epstein, EdD, Center for Child and Family Well-Being, University of Nebraska–Lincoln, Lincoln, NE, USA. Ronald W. Thompson, PhD, Boys Town National Research Institute, Boys Town, NE, USA. Thomas F. Tonniges, MD, Boys Town Institute for Child Health Improvement, Boys Town, NE, USA.
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Journal of Behavioral Health Services & Research, 2013. 36–45. c 2012 National Council for Community Behavioral Healthcare.
36
The Journal of Behavioral Health Services & Research
40:1
January 2013
Introduction In an era of high health care costs and increasing emphasis on efficiency, medical service utilization is an important topic for study.1,2 Research in this area has produced several consistent findings: (1) individual service utilization rates vary widely;3 (2) a subset of the population which consumes a disproportionate share of the services provided can be identified as “high utilizers”;4,5 and (3) there is some stability in utilization patterns over time.2,3,6 These findings have led to an interest in studying patterns and predictors of utilization, with the hope that understanding the factors that contribute to high levels of service utilization could support interventions to reduce costly service use.7,8 Along these lines, the present study examined the predictors of service utilization for a high risk pediatric population, specifically youth in a large residential treatment program. Youth in residential treatment comprise an important group to study with respect to service utilization. In addition to representing a sizable group nationally (approximately 200,000),9 youth in residential treatment may be at particular risk for high service utilization due to elevated rates of physical health problems,10 psychopathology,11–13 and environmental risk factors (e.g., poverty, family stressors).14 High rates of medical service use have been reported for other out-of-home placement groups such as youth in foster care;15,16 however, only a limited amount research is available on the predictors of service use for youth in residential care. Further, the range of severity in psychopathology among this population makes it ideal for studying the complex interplay between mental health problems, physical health status, and medical service utilization.
Predictors of medical service utilization An emerging body of research has begun to examine the various factors associated with service utilization rates in the general pediatric population. Much of this research has focused on demographic factors believed to directly influence medical service use such as age, ethnicity, and family income.17,18 Findings for age and ethnicity have been mixed depending
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