Wait Time and Documentation Required for Child Psychiatric Care Across Payer and Facility Types

OBJECTIVE: Long wait times and stringent documentation requirements, such as identification and guardianship paperwork, can limit access to outpatient child psychiatric care at academic medical centers (AMCs) and community health centers (CHCs). This cross-sectional study aimed to compare quoted wait times and documentation requirements for obtaining child psychiatric appointments across payer types (Blue Cross Blue Shield [BCBS], Medicaid, and self-pay) at CHCs and AMCs. METHODS: Between January and September 2024, data were collected via telephone survey from 70 nationally ranked AMCs and 68 CHCs. Generalized estimating equations were used to assess the associations of payer type and facility type with wait time and required documentation. RESULTS: Wait times at CHCs were shorter than at AMCs (mean±SD=43.0±3.7 vs. 119.8±19.4 days, p<0.001). Medicaid patients waited longer than self-pay patients at CHCs (mean=48.7±29.3 vs. 32.0±25.7 days, p=0.021) and longer than BCBS patients at AMCs (mean=160.9±136.4 vs. 77.1±87.5 days, p=0.022). Documentation requirements were higher at CHCs compared with AMCs (mean=2.2±1.4 vs. 1.4±1.1 documents, p<0.001), although Medicaid patients (mean=1.9±1.2 documents) at CHCs were asked to provide fewer documents than BCBS or self-pay patients (mean=2.5±1.4, p=0.032, and mean=2.5±1.7, p=0.030, respectively). CONCLUSIONS: Pediatric patients had shorter wait times at CHCs than at AMCs, although more documents were required. Future policy work and research should focus on how health care systems can reduce child psychiatric wait times and documentation burdens.