Study Finds Gaps in Mental Health Care for Children in Medi-Cal

A study in February's Journal of the American Academy of Child and Adolescent Psychiatry indicates "serious gaps" in mental health services for children enrolled in Medi-Cal, the Sacramento Bee reports.

Researchers, who conducted the state-commissioned study at four University of California campuses, analyzed medical records from August 1998 to June 1999 for 813 children ages six to 17 who received mental health services and were enrolled in Medi-Cal. Researchers analyzed more than 100 indicators of quality care.

According to the study, psychotropic prescriptions for children have increased two to three times in the past decade, a rate "outpac[ing] the scientific evidence to support their effectiveness and safety," the Bee reports. According to the study, fewer than one-third of children taking such medications were monitored for changes in their weight, pulse, blood pressure and liver function.

Principal investigator Bonnie Zima, a researcher with the University of California-Los Angeles Neuropsychiatric Institute, said, "There is concern about increasing use of psychotropic medications among children. We want to be able to rule out any medical conditions that might be affecting a child's behavior or emotion."

Zima also noted the study found that fewer than 40% of children were receiving physical exams. In addition, in fewer than 30% of cases, a physician checked for more than one vital sign or conducted more than one laboratory study recommended for a particular treatment. Zima said, "During a three-month evaluation period, we expected there to be some notation in the chart of findings of a child's annual physical or a referral for one."

The study also found that half of children receiving state-funded mental health services were not screened for child abuse; in one-fourth of cases there was no consent form to allow the doctor to share information with patients' teachers or caseworkers; and half of all parents or other family members had not been included in counseling services.

Researchers, however, "were heartened" to find that the quality of care was consistent among demographic groups and urban and rural areas, according to the Bee. They also found that private providers contracted to serve Medi-Cal beneficiaries provided care "fairly consistent" with county clinics, the Bee reports.

Joseph Sison, medical director for Children's Mental Health Care in Sacramento County, said, "Should the community be monitoring these agents more closely? Yes." He added, "These medications are not innocuous in terms of side effects."

"The bad news is that the documentation and engagement of the families isn't what it should be," Stephen Mayberg, director of the Department of Mental Health, said. But he added, "The system is really taking difficult kids and by and large doing the right thing." He said that DMH would "deal with the problems before they escalate" (Griffith, Sacramento Bee, 1/20).