10 - Pediatric Behavioral Health Systems Trends: 2010-2016

Poster Number: 10
Publication Number: 10.414

Patricia A. Stoeck, Boston Children's Hospital, Boston, MA, United States; Morgan Shields, Perelman School of Medicine at the University of Pennsylvania, philadelohia, PA, United States; Sifan Lu, SUNY Downstate, Brooklyn, NY, United States; Evan Dalton, Children’s Hospital of Philadelphia, Philadelphia, PA, United States; Nicholas Carson, Harvard Medical School, Cambridge, MA, United States; Mihail Samnaliev, Boston Children's Hospital, Boston, MA, United States; Nancy Beaulieu, Harvard Medical School, Boston, MA, United States; David Cutler, Harvard University, Cambridge, MA, United States; Alyna T. Chien, Division of General Pediatrics, Boston Children's Hospital, Brookline, MA, United States

Background: Concerns about the adequacy of pediatric behavioral health (BH) care in the United States pre-date the current COVID-19 pandemic. It is not known how changes in the size and complexity of health care organizations have positioned pediatric primary care providers (PCPs) in multispecialty practices with psychiatrists or created pediatric BH systems capable of delivering pediatric BH services across the outpatient-inpatient continuum.

Objective: For 2016 relative to 2010, we examine the percent change in the number of: 1. Multispecialty practices with both pediatric PCPs and psychiatrists; 2. Hospitals with inpatient child/adolescent psychiatry services; and 3. Pediatric BH systems in the US.

Design/Methods: This study uses longitudinal data from the novel Health Systems and Provider Database, 2010-2016, a census of physicians, hospitals, and health systems in the United States. We defined the pediatric BH workforce as inclusive of general pediatricians, family practitioners, child/adolescent psychiatrists, and general psychiatrists. PCPs and psychiatrists were considered to be in multispecialty practice together if at least one pediatric PCP and one psychiatrist was billing to the same practice identifier. Hospitals were considered capable of providing inpatient child/adolescent BH services if they indicated as such on service line inventories. Pediatric BH systems were defined as pediatricians, child/adolescent psychiatrists, and inpatient child/adolescent psychiatry all present in the same organization. For all measures, percent change was measured by subtracting 2010 values from 2016 and dividing by the base year 2010. Since the data are a census, not a sample, we provide point estimates only.

Results: Over the study period, the number of multispecialty practices grew by 52%, from 1744 in 2010 to 2648 in 2016. The number of hospitals with inpatient child/adolescent psychiatry rose by 36% (550 in 2010; 747 in 2016); children’s hospitals providing these services grew 83% (40 in 2010; 73 in 2016). The number of pediatric BH systems increased by 81% (134 in 2010; 243 in 2016). Within systems, the number of pediatricians increased by 228% (mean 18 in 2010; 59 in 2016) and the number of child/adolescent psychiatrists rose by 60% (mean 5 in 2010; 8 in 2016), while the number of member hospitals remained stable (mean 5 in 2010 and 2016).Conclusion(s): Pediatric BH practices and systems have been growing in prevalence and size, but need to be evaluated for the degree to which they deliver desired outcomes for BH needs that continue to expand.

Percent Increase in Practices, Hospitals, and Behavioral Health Systems, 2010-2016Figure: Trends in multispecialty practices (blue), inpatient child/adolescent psychiatry (orange), and pediatric behavioral health systems (gray) between 2010 and 2016. Shown are percentage changes per year, relative to 2010.