Location of Crisis Service Delivery for Medicaid-Enrolled Youths With Behavioral Health Conditions

OBJECTIVES: National guidelines emphasize the value of community-based behavioral health crisis care for youths, including mobile crisis response and telehealth. This study aimed to assess characteristics associated with receipt of crisis care via mobile or community services and telehealth among Medicaid-enrolled youths. METHODS: A retrospective study was conducted of a national sample of youths ages 6-17 years who received crisis services and had data in the 2022 Merative MarketScan Medicaid database. Locations of care included mobile or community, telehealth (i.e., virtual), in-person onsite (e.g., hospitals), and other. Multivariable logistic regression was used to evaluate sociodemographic and clinical factors associated with receipt of crisis services via mobile or community response and via telehealth. RESULTS: The sample included 18,993 youths who received behavioral health crisis services in 2022. The most frequent service location was in person onsite (63.0%), followed by mobile or community (29.2%), other (9.3%), and telehealth (9.1%). Compared with results for White youths, the odds of receiving crisis care via mobile or community services were higher for Black youths (adjusted odds ratio AOR=1.12) and Hispanic youths (AOR=1.26), and the odds of receiving crisis care via telehealth were higher for Black youths (AOR=1.30) and lower for Hispanic youths (AOR=0.05). CONCLUSIONS: Despite recommendations that prioritize community-based behavioral health crisis care, most crisis services occurred in person onsite. Racial-ethnic differences were found in receipt of mobile or community and telehealth crisis care. Future research to investigate facilitators, barriers, and preferences may enable more youths to receive community-based crisis care.