Prevention and early intervention are essential to reduce the negative consequences of mental health and substance abuse conditions. Mathematica has examined a wide range of prevention and intervention programs targeted at children, adolescents, and adults who have or are at risk for mental health and substance abuse problems. For example, we evaluated outreach, screening, and treatment programs aimed at improving birth outcomes among pregnant Medicaid beneficiaries with substance abuse problems. We have also evaluated programs that partner with Head Start to prevent substance abuse among at-risk families. In other areas, we have produced technical assistance guides to help administrators of Temporary Assistance to Needy Families (TANF) programs integrate alcohol and drug treatment with mental health services for their clients. Currently, we are studying Bright Beginnings and Personal Best, two interventions conducted by the Ackerman Institute for the Family to promote the mental health of new mothers and young children.

Our work focusing on child and adolescent mental health has informed the development of policies and services that may reduce the likelihood of persistent mental illness into adulthood. For example, we have examined financing mechanisms states have used to deliver community-based mental health services for children as an alternative to residential treatment. We are examining the extent to which residential treatment providers are implementing family-driven and youth-guided care and whether this care is integrated into community-based systems for children. We are also using Medicaid claims data to examine characteristics of youth who use residential and inpatient services for mental health conditions. Some of our other work involves examining mental health conditions among children involved in foster care and developing models of treatment to improve delivery of mental health services in pediatric primary care.

Access to services and programs for individuals with mental health and substance use conditions remains a significant public health problem. Mathematica has a long history of studying mental health insurance coverage and assessing costs of insurance for related conditions. Our evaluations of mental health and substance abuse insurance parity for Vermont and California helped inform the parity policy debate in these states and nationally. We have also examined the cost of providing mental health and substance abuse benefits through the State Children’s Health Insurance Program. Our work has addressed barriers that involve provider knowledge and workforce issues. For example, we are conducting an evaluation of the SOAR Initiative, a federal effort to improve the ability of case managers to obtain SSI/SSDI benefits for homeless individuals, many of whom have serious and persistent mental health problems.

Mathematica has conducted key research to understand how mental health and substance abuse services are organized and financed. For example, we completed evaluations of the impact of Medicaid waivers on use of mental health services. Our experience includes extensive use of Medicaid claims data to examine costs of mental health services and service use patterns.  Mathematica has also examined the organization of programs designed by state and local welfare systems to address welfare recipients’ mental health needs. We have looked at the costs of supportive housing and other assistance for individuals with severe mental illness. Several projects have looked at how mental health and substance abuse services are organized and financed under managed care arrangements.  Finally, we have examined regulation and financing of group homes and residential treatment facilities for both adults and children.

Many of our early childhood, education, welfare, and employment projects have evaluated mental health and substance abuse outcomes. For example, our evaluation of the Health Link program examined whether aftercare services help former prisoners reduce their drug use and reintegrate into the community.  We have also examined parent satisfaction with child mental health services among Department of Defense beneficiaries. Mathematica has looked at whether linking ambulatory substance abuse treatment and medical care is associated with improved outcomes for HIV-positive substance abusers.

In the methodological arena, Mathematica is a leader in developing and applying methods to collect data directly from individuals with mental health or substance abuse problems as well as individuals with developmental disabilities. Our staff is experienced in working with these groups to accurately and appropriately assess outcomes and gather their perspectives.

Getting better data on substance abuse and mental illness treatment is the first step in improving programs. For the Substance Abuse and Mental Health Services Administration, we have analyzed how to improve three large data systems on treatment and prevention programs nationwide. We also redesigned instruments and procedures for an annual survey of substance abuse treatment facilities. Another study compared the data systems used by Medicaid, Medicare, and the private sector to determine the best way of studying managed behavioral health care at the national level. Mathematica has also contributed to the design and collection of the National Treatment Outcomes Monitoring System.