Problem: Rural children are less likely than their urban counterparts to obtain needed mental health care (Howell and McFeeters, 2008; Lambert et al., 2008) and have limited access to all needed services (Lenardson et al., 2010). However, these studies have been limited by lack of detail about mental health visits and absence of information about psychotropic drug use. Prior research indicates that privately insured, non-elderly adults have lower use of office-based mental health services, but higher use of prescription medicines than their urban counterparts, raising questions about quality and outcomes (Ziller in press). In one study of very young children, the number of children receiving antipsychotic medications increased over a 3-year period, though very few children using antipsychotics received a formal mental health assessment, a psychotherapy visit, or a visit with a psychiatrist during the year of antipsychotic use (Olfson et al., 2010).

Project Goals: We will address two study questions: 1) Do patterns of children's mental health service use (e.g., office visits and psychotropic medications, alone or in combination) differ by rural-urban residence? and 2) What role does family income, type of insurance and availability of mental health providers have on the use of mental health services?

Methods: This study will conduct bivariate and multivariate analyses of the 2003-2008 panels of the Medical Expenditure Panel Survey (MEPS), which includes data on self-reported mental health problems, office-based visits, and prescribed medicines. With permission, the MEPS can be linked to the Rural-Urban Continuum Code to examine rural areas adjacent and not adjacent to urban areas.

Anticipated Products/Products: Anticipated products include a Working Paper and associated Research and Policy Brief and, if warranted, submission to a peer-reviewed journal. Additionally, abstracts will be submitted for presentation at the annual meetings of the National Rural Health Association, AcademyHealth, and other organizations with an interest in children's mental health.

Publications

• Patterns of Care for Rural and Urban Children With Mental Health Problems
  Maine Rural Health Research Center
  Date: 06/2013
  This study reports that rural children are significantly less likely to be diagnosed and treated for non-ADHD mental health problems than urban children and are less likely to receive mental health counseling.