U.S. Child Behavioral Health Quality Measures: Advancing a National Research Agenda

This paper is based on the keynote presentation for the biennial meeting of the International Society for Research on Child and Adolescent Psychopathology (ISRCAP) in Los Angeles, California. The topic was purposively selected to raise awareness of how the measurement of child behavioral health care quality at the national level, and corresponding standards for reliability and clinical validity, substantially differ from those traditionally applied to the measurement of child psychopathology. Under a federal mandate, an initial Core Set of quality measures for children was created for voluntary reporting by State Medicaid agencies. The four national child behavioral health quality measures in the 2019 Child Core Set encompass timeliness of care, vary by child age range, and two different types of psychotropic medication treatments. Measures are described and implications for data interpretation are provided. Findings are summarized from: 1) a systematic literature review; 2) State adherence rates; and 3) ten-year national trends in adherence rates by health plan type. Scientific evidence supporting the clinical validity of the measures is scarce, statewide adherence rates widely vary, and improvement over time has been modest. Nevertheless, State Medicaid agencies will be mandated to report measure adherence rates beginning in 2024. Together, these findings stimulate recommendations for health policies to allocate additional resources for data infrastructure to monitor child mental health care quality and identify areas for future research.