Identifying Access to Mental Healthcare Services for Pediatric Patients Living with Sickle Cell Disease

Introduction: Pediatric patients living with sickle cell disease (SCD) are at increased risk for secondary mood disorders and are in need of access to mental healthcare. It is critical to identify whether pediatric patients with SCD, who disproportionally live in the Southeast United States, have access to quality mental healthcare. The current study assessed access to mental healthcare services and resources based on local community.

Methods: This single-center study was developed as part of the Miree Leadership Project through Altamont High School in Birmingham, Alabama. A list of currently licensed psychologists practicing in the state of Alabama was obtained from the Alabama Board of Examiners in Psychology. Psychologists were categorized as pediatric or adult providers. Medicaid providers were identified using the Alabama Medicaid public provider directory. Number of sickle cell patients living in each county were identified using the Alabama Lifespan Sickle Cell Tracking Access Towards Equality (ALSTATE) Network funded through the Center for Disease Control (CDC) as part of the Sickle Cell Data Collection (SCDC) project. Counties were classified as rural or urban utilizing the Alabama Rural Health Association database. Lastly, the CDC social vulnerability index (SVI) was obtained to identify socially vulnerable communities in Alabama. Descriptive statistics and two sided t-tests were performed; significance was set at p <0.05.

Results: We identified 131 licensed psychologists as providing pediatric-specific mental health services in Alabama. Primary practices were located in 16 (24%) out of the 67 counties in Alabama. Next, we identified 1,421 pediatric patients living with SCD who reside in 62 of the 67 counties in Alabama. The primary insurance for 87% of pediatric patients with SCD in Alabama is Medicaid (n = 1240). 983 pediatric patients with SCD live within 16 counties with a licensed pediatric psychologist. However, almost one third (n=438) of pediatric patients with SCD live in counties without a licensed pediatric psychologist. Counties without a pediatric psychologist for patients with SCD have a higher percentage of the population living below the 150% poverty level (31.0 vs 26.0%, p=0.03) and percentage of people (25 years and older) without a high school diploma (16.5 vs 11.8%, p<0.0001). Counties without a licensed psychologist had a higher percentage of households with no vehicle approaching significance (p=0.07). Among the 12 urban counties with a pediatric patient with SCD, ten (83%) counties have a licensed pediatric psychologist; five urban counties have a licensed psychologist (n=25) accepting Medicaid patients. Only six (12%) of the 50 rural counties with a pediatric patient with SCD have a licensed psychologist; four rural counties have a licensed psychologist (n=6) accepting Medicaid patients

Conclusion: Almost one third of pediatric patients living with SCD do not have access to a licensed psychologist in their counties. Further, only nine counties have licensed psychologists accepting Medicaid insured pediatric patients. This represents a significant mental health disparity for pediatric patients living with SCD, especially among rural counties with high levels of poverty. Overall, these findings emphasize the need for interventions and policy change to increase access to quality mental health services to pediatric patients living with SCD. The next steps will be to engage additional high school students throughout Alabama to work with local and state officials to improve access to mental health care for pediatric patients.