Mind the Gap: A Comparative Analysis of Adolescent Mental Health, Social Determinants of Health, and Medicaid Policy in North Carolina

Abstract

This study examines the relationship between adolescent mental health care, social determinants of health, and the development of Medicaid across two North Carolina counties. Specifically, this thesis focuses on Durham County, a relatively urban area with several unincorporated suburbs, and Transylvania County, a rural community of approximately 30,000 inhabitants. Much research has been conducted on the relationship between social determinants of health, and access to and quality of adolescent mental health care. However, the multi-dimensional relationship between all three variables, as well as the influence of Medicaid policy and service innovations, remains unsettled. Through qualitative interviews and inductive analysis, this thesis investigates the differences between how adolescent mental health care is provided in each community. Additionally, it explores the extent to which adolescent mental health services address social determinants of health, and the role of Medicaid policy in the perceived effectiveness of those initiatives. Qualitative analysis of 15 interviews with healthcare providers, community leaders, and Medicaid care managers suggests that the mechanisms by which adolescent mental health and social determinants of health are addressed differ between the two counties, with clinical and nonprofit efforts emphasized in Durham and Transylvania Counties respectively. Yet in both communities, the efforts perceived as most successful rely on collaboration and community organization across various stakeholder groups. Across all interviews, challenges of healthcare access, fragmentation, and discontinuity of care emerged, highlighting a discrepancy between how behavioral health and SDOH innovations are proposed and how they truly affect North Carolinian adolescents.