Health service access across racial/ethnic groups of children in the child welfare system.
Health service access across racial/ethnic groups of children in the child welfare system.
复制标题
儿童福利系统中跨种族/族裔群体的儿童获得医疗服务的机会。
DOI：
10.1016/j.chiabu.2008.11.003
复制
发表时间：
2009
影响因子：
4.8
通讯作者：
Belue,Rhonda
中科院分区：
文献类型：
--
作者：
Wells,Rebecca;Hillemeier,MarianneM;Bai,Yu;Belue,Rhonda
PROTETIVEThis study examined health service access among children of different racial/ethnic groups in children welfare system in attempt to identify and explain variables. METHODS数据来自全国儿童和青少年健康调查（NSCAW）。描述性统计量N = 2，505。多元回归模型的N =537。各项措施反映了儿童保健服务的需要、获得机会和有利因素。使用卡方检验和t检验比较人种/种族组。Logistic回归模型进一步探讨了最大的差距确定，即非拉丁美洲/黑人和白色儿童之间的个案工作者报告获得咨询。然而，拉丁美洲/a儿童有更好的报告获得视力服务比非拉丁美洲/a白色儿童，和咨询访问是较低的非拉丁美洲/a黑人儿童比非拉丁美洲/a白色儿童。个案工作者的自我报告的努力，以促进服务的访问没有不同的种族/族裔的任何类型的医疗保健。在多元回归模型中，私人医疗保险和缺乏保险与咨询服务呈负相关，而性虐待史，青春期和更大的个案工作者努力确保服务与访问呈正相关。在控制了其他影响访问的因素后，种族几乎不显着。CONCLUSIONSONS为什么黑人儿童不太可能被确定为需要咨询的一个可能的原因是，他们不太可能比白色儿童有性虐待的报告，这强烈预测咨询访问。儿童的种族/族裔群体报告的保健服务获得情况大致相当。其次，个案工作者可能对黑人儿童的咨询服务需求认识不足，尽管这可能反映了黑人儿童性虐待的报告不太频繁。第三，私人保险和未保险的儿童比公共保险的儿童更不可能接受必要的心理健康咨询。这表明，政策制定者应该把重点放在增加儿童参加公共医疗保险计划，如医疗补助和国家儿童健康保险计划（SCHIP）的人数。
OBJECTIVEThis study examined health service access among children of different racial/ethnic groups in the child welfare system in an attempt to identify and explain disparities.METHODSData were from the National Survey of Child and Adolescent Well-Being (NSCAW). N for descriptive statistics=2,505. N for multiple regression model=537. Measures reflected child health services need, access, and enabling factors. Chi-square and t tests were used to compare across racial/ethnic groups. A logistic regression model further explored the greatest disparity identified, that between non-Latino/a Black and White children in caseworker-reported access to counseling.RESULTSIn general, caseworker reports of health care service receipt did not differ across racial/ethnic groups. However, Latino/a children had better reported access to vision services than non-Latino/a White children, and counseling access was lower for non-Latino/a Black children than non-Latino/a White children. Caseworkers’ self-reported efforts to facilitate service access did not vary by race/ethnicity for any type of health care. In the multiple regression model, both private health insurance and a lack of insurance were negatively associated with counseling access, while a history of sexual abuse, adolescence, and greater caseworker effort to secure services were positively associated with access. Race was just barely nonsignificant after controlling for other factors expected to affect access.CONCLUSIONSOne possible reason why Black children are less likely to be identified as needing counseling is the fact that they are less likely than White children to have reports of sexual abuse, which strongly predicts counseling access.PRACTICE IMPLICATIONSFirst, child welfare practice may be more equitable than many believe, with generally comparable health service access reported across children's racial/ethnic groups. Second, caseworkers may be under-identifying need for counseling services among Black children, although this might reflect less frequent reports of sexual abuse for Black children. Third, both privately insured and uninsured children were less likely to receive needed mental health counseling than those with public insurance. This suggests that policy makers should focus on increasing the numbers of children enrolled in public health insurance programs such as Medicaid and the State Children's Health Insurance Program (SCHIP).