African American/white disparities in psychiatric emergencies among youth following rapid expansion of Federally Qualified Health Centers

Objective: To test whether rapid expansion of mental health services in Federally Qualified Health Centers (FQHCs) reduces African American/white disparities in youth psychiatric emergency department (ED) visits. Data Sources: Secondary ED data for psychiatric care for 3.3 million African American and white youth in nine states, 2006-2011. We used the HCUP SEDD and SID. We obtained FQHC service data from the Uniform Data System. Study Design: The psychiatric ED visit is the dependent variable. Logistic regression methods control for individual risk factors for ED use, as well as county-level health system factors and county and year fixed effects. Key independent variables include indicators of mental health service capacity in FQHCs in a county-year. Data Extraction Methods: We extracted ED psychiatric visits for 3.3 million African American and white youth in nine states, 2006-2011, from the HCUP SEDD and SID, and FQHC data from the Uniform Data System. Principal Findings: Overall mental health visits at FQHCs correlate positively with psychiatric ED visits among African American youth. However, increases in the number of mental health visits per FQHC patient corresponds with fewer outpatient psychiatric ED visits among African American youth, relative to white youth (odds ratio = 0.96; 95% CI = 0.94, 0.98). Conclusions: Increases in the intensity of services offered per mental health patient at FQHCs—rather than increases in overall capacity—may reduce African American youth's overreliance on the ED for psychiatric care.