TY - JOUR
KW - Adolescent
KW - Alcoholism/economics/epidemiology/rehabilitation
KW - Comorbidity
KW - Costs and Cost Analysis
KW - Cross-Sectional Studies
KW - Evidence-Based Practice/economics
KW - Female
KW - Financing, Government
KW - Health Care Costs/statistics & numerical data
KW - Health Care Reform/economics
KW - Health Services Accessibility/economics
KW - Health Services Needs and Demand/economics/statistics & numerical data
KW - Humans
KW - Male
KW - Reimbursement Mechanisms/economics
KW - Socioeconomic Factors
KW - Substance-Related Disorders/economics/epidemiology/rehabilitation
KW - United States
AU - S. Sterling
AU - C. Weisner
AU - A. Hinman
AU - S. Parthasarathy
A1 - 
AB - OBJECTIVE: To review the research on economic and systemic barriers faced by adolescents needing treatment for alcohol and drug problems, particularly those with co-occurring conditions. METHOD: We reviewed the literature on adolescent access to alcohol and drug services, including early intervention, and integrated and specialty mental health treatment for those with co-occurring disorders, examining the role of health care systems, public policy (health reform), treatment financing and reimbursement systems (public and private), implementation of evidence-based practices, confidentiality practices, and treatment costs and cost/benefits. RESULTS: Barriers to treatment, particularly integrated treatment, are largely rooted in our organizationally fragmented health care system, which encompasses public and private, carved-out and integrated systems, and different funding mechanisms (Medicaid versus block grants versus private insurance that include "high deductible" plans and other cost controls.) In both systems, carved-out programs de-link services from other mental health and general health care. Barriers are also rooted in disciplinary differences and weak clinical linkages between psychiatry, primary care and substance use, and in confidentiality policies that inhibit communication and coordination, while protecting patient privacy. CONCLUSION: In this era of health care reform, we have the opportunity to increase access for adolescents and develop new models of integrated services for those with co-occurring conditions. We discuss opportunities for improving treatment access and implementation of evidence-based practices, examine implications of health reform and parity legislation for psychiatric and substance use treatment, and comment on key unanswered questions and future research opportunities.
BT - Journal of the American Academy of Child and Adolescent Psychiatry
C5 - Financing & Sustainability; Healthcare Policy
CP - 7
CY - United States
DO - 10.1016/j.jaac.2010.03.019
IS - 7
JF - Journal of the American Academy of Child and Adolescent Psychiatry
N2 - OBJECTIVE: To review the research on economic and systemic barriers faced by adolescents needing treatment for alcohol and drug problems, particularly those with co-occurring conditions. METHOD: We reviewed the literature on adolescent access to alcohol and drug services, including early intervention, and integrated and specialty mental health treatment for those with co-occurring disorders, examining the role of health care systems, public policy (health reform), treatment financing and reimbursement systems (public and private), implementation of evidence-based practices, confidentiality practices, and treatment costs and cost/benefits. RESULTS: Barriers to treatment, particularly integrated treatment, are largely rooted in our organizationally fragmented health care system, which encompasses public and private, carved-out and integrated systems, and different funding mechanisms (Medicaid versus block grants versus private insurance that include "high deductible" plans and other cost controls.) In both systems, carved-out programs de-link services from other mental health and general health care. Barriers are also rooted in disciplinary differences and weak clinical linkages between psychiatry, primary care and substance use, and in confidentiality policies that inhibit communication and coordination, while protecting patient privacy. CONCLUSION: In this era of health care reform, we have the opportunity to increase access for adolescents and develop new models of integrated services for those with co-occurring conditions. We discuss opportunities for improving treatment access and implementation of evidence-based practices, examine implications of health reform and parity legislation for psychiatric and substance use treatment, and comment on key unanswered questions and future research opportunities.
PB - American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc
PP - United States
PY - 2010
SN - 1527-5418; 0890-8567
SP - 46; quiz 725
EP - 6
EP - 637+
T1 - Access to treatment for adolescents with substance use and co-occurring disorders: Challenges and opportunities
T2 - Journal of the American Academy of Child and Adolescent Psychiatry
TI - Access to treatment for adolescents with substance use and co-occurring disorders: Challenges and opportunities
U1 - Financing & Sustainability; Healthcare Policy
U2 - 20610133
U3 - 10.1016/j.jaac.2010.03.019
VL - 49
VO - 1527-5418; 0890-8567
Y1 - 2010
ER -