Professional Abstract

Objective

To assess the effect of short-term family navigator services on parent and child outcomes among families with children on Medicaid who take antipsychotics

Study Design

Design Element	Description
Design	Randomized controlled trial
Population	348 parents of children ages 16 and younger who were approved for antipsychotic medication and have Medicaid
Interventions/ Comparators	Family navigator services Usual care
Outcomes	Primary: parent-reported empowerment, social support, and satisfaction with child mental health treatment Secondary: parent-reported child global behavioral functioning, child use of behavioral therapy services, and antipsychotic medication dose changes
Timeframe	90-day follow-up for primary outcomes

This randomized controlled trial compared family navigator services with usual care. The study included 348 parents of children ages 16 and younger, on Medicaid, and approved to take antipsychotic medication in Maryland. In this study, 93% of parents were female, 56% were white, 34% were African American, and 10% were other races.

Researchers randomized parents to one of two groups. Parents in the family navigator group received one-on-one telephone support from family navigators for 90 days. Navigators were parents on the research team with experience raising children who needed mental health services. Parents in the study chose when, how often, and how long they spoke with family navigators. The family navigators provided emotional support and referrals for psychosocial services and other resources to address family needs identified by the parents. Parents in the usual-care group continued normal medical care and monitoring for their children. At the end of the study, the research team gave parents in this group information on parent-support programs.

Parents completed surveys at enrollment and after 90 days. The surveys asked about parent empowerment, social support, satisfaction with child mental health treatment, and their child’s global behavioral functioning. The research team compared behavioral-therapy service claims made by parents in both groups in the 90 days before and after enrollment. The team also used pharmacy claims to assess whether the antipsychotic medication dose and number of psychiatric medications had changed after 90 days.

An advisory board of parents, child healthcare providers, and child service representatives helped to design and implement the study.

Results

After 90 days, the study found no statistically significant differences between the family navigator and usual-care groups in changes in ratings of parent empowerment, social support, satisfaction with children’s mental health treatment, or children’s global behavioral functioning. In addition, there were no differences in therapy service claims between the two groups. Children of parents who received family navigator services were less likely to have an increase in antipsychotic medication dose than those who received usual care (p=0.01). There were no statistically significant differences between the two groups in the proportion of children who switched or stopped using antipsychotic medications.

Parents had an average of four sessions with their family navigators. In addition to mental health needs, many parents asked family navigators for assistance with food services (35%) and for information on housing programs (29%). Family navigators also identified and reported four cases of suspected child abuse or neglect to Child Protective Services.

Limitations

The intensity of the intervention—using only phone calls with family navigators—and the 90-day follow-up may have been insufficient to promote greater improvement in parent-reported outcomes for the intervention group. The research team did not have direct contact with the children or observe the parents and children together, which may have limited the family navigator program’s ability to improve the study outcomes.

Conclusions and Relevance

Families with children who take antipsychotic medication and receive Medicaid have complex health needs related to economic adversity and mental health concerns. Although there were no differences in the primary outcomes between the two groups, many parents asked family navigators for assistance with managing basic living needs.

Future Research Needs

Future studies could further explore modes of providing support to parents of children who need mental health services. Future research could also specifically address the ability of these services to address common daily living needs among families with children who take antipsychotics and have Medicaid.