Health System Surveillance to Advance Mental Health Parity for Children

ABSRACTO_ST_ABSObjectiveC_ST_ABSParity between physical and mental health for insured individuals is protected by federal law but unfulfilled, in part, because deficiencies are notoriously difficult to document. MethodsWe implemented real-time, systematic clinical documentation of gaps in access to mental health services for an outpatient cohort representing 2,149 children discharged from Childrens Healthcare of Atlanta emergency departments for behavioral crisis May-Dec 2024. ResultsSixty percent of patients discharged to the community with clear recommendations for expedited follow up were not receiving any service at 30-75-days. For those internally referred to the systems outpatient psychiatric practice, the documentation system confirmed medical necessity and captured accessibility or non-accessibility for each element of evidence-based care of each patients treatment plan. ConclusionFeasible revisions of electronic health record documentation, coupled with clinical accountability pathways can enable health systems to assume responsibility for continuous, real-time epidemiologic estimation of gaps in the adequacy of provider networks to meet the mental health needs of insured children. HighlightsWe modeled health-system-based surveillance of gaps in access to medically necessary mental health care for children, toward fulfillment of federal mental health parity law. Health system-based monitoring of unmet needs was feasible and generated real-time epidemiologically-relevant estimates of gaps in community capacity for mental health services