Assessing the impacts of Medicaid Home and Community Based Waivers for children with Severe Emotional Disturbance

评估医疗补助家庭和社区豁免对患有严重情绪障碍的儿童的影响

基本信息

批准号：
10429717
负责人：
Genevieve Graaf
金额：
$ 16.68万
依托单位：
UNIVERSITY OF TEXAS ARLINGTON
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-05-01 至 2026-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10429717
关键词：
Accounting Achievement Address Administrator Americans with Disabilities Act Caring Characteristics Child Child Care Clinical Communities Community Services Complex Data Data Analyses Data Collection Data Reporting Data Set Decision Making Diagnosis Disease Distress Effectiveness Enrollment Environment Exhibits Expenditure Family Financial Hardship Funding Goals Grant Health Health Policy Health financing Healthcare Home Home Ranges Improve Access Income Individual Inpatients Instruction Intervention Knowledge Laws Long-Term Care Medicaid Medicaid services Mentors Mentorship Methodology Modeling National Institute of Mental Health Outcome Parents Participant Policies Provider Psychiatric therapeutic procedure Public Health Research Research Design Research Methodology Research Personnel Residential Treatment Resources Risk Risk Factors Services Severities Source Statistical Methods Strategic Planning Structure Symptoms System Techniques Texas Time Time Study Training United States Variant Writing Youth alternative treatment base behavior measurement behavioral health community based service cost data management experience health care service utilization health service use improved improved functioning non-compliance novel patient home care prevent programs residential care facility serious emotional disturbance service intervention service utilization skills statistics symposium training opportunity waiver

项目摘要

PROJECT SUMMARY The overall goal of this K01 application is to estimate the impact of 1915(c) Home and Community-Based Services (HCBS) Medicaid waiver programs for children with Severe Emotional Disturbance (SED) on behavioral health care service use and expenditures for children with SED. Children with severe SED are at significant risk for psychiatric long-term care (LTC) use due to the severity of their symptoms and inability to access alternative community-based behavioral health care. To reduce public financial burdens and family distress associated with use of psychiatric LTC, one in five states offer 1915(c) HCBS Medicaid waiver policies. These policies expand the Medicaid-funded community-based service array for children who exhibit a clinical need for institutional psychiatric care, regardless of family income levels. Though these policies are intended to prevent psychiatric LTC use by providing alternative community-supports, achievement of these goals is unclear. Scant existing research lacks either causal inference or generalizability, as they are cross sectional, regional, or minimally control for clinical variation in program participants. The goal of this K01 is to train the recipient in the statistical and methodological skills needed to study the impacts of health policy on service utilization and expenditure outcomes for children and youth with complex behavioral health needs. Research aims are to 1) create a comprehensive SED waiver policy dataset that codifies the structures and provisions of these policies across states and over time, 2) identify and compare characteristics of children enrolled in SED waiver programs and children who use psychiatric LTC among Medicaid-enrolled children with behavioral health disorders; 2b) assess SED waiver policies and waiver program enrollment’s association with amelioration of adverse risk factors for LTC, and 3) estimate the effects of the Texas SED Waiver and its characteristics on Medicaid-reimbursed behavioral health service use and expenditures. The training aims of the project are to 1) acquire knowledge, skill, and experience in public health law research methods, 2) build knowledge on the assumptions and applicability of research designs and statistical methods for estimating causal effects of behavioral health policy interventions using observational and administrative data, 3) apply current and best practices for defining and measuring behavioral health service use and expenditures using diverse sources of health claims data and 4) obtain the research, writing, and administrative expertise to submit a successful R01 grant during the final year of the K01. Training aims will be accomplished through formal coursework, individualized instruction, seminar and workgroup participation, mentored research, and conference participation. Research aims will use data from state SED waiver applications merged with Medicaid claims data from state and federal resources. This project will provide novel evidence for policymakers nationwide regarding which children may be at risk for psychiatric institutional care, the policy or service interventions that may reduce these risks, and what costs may be associated with these interventions.

项目摘要该K01应用程序的总体目标是估计1915年（C）家庭和基于社区的影响服务（HCBS）针对严重情绪障碍（SED）儿童的医疗补助计划 SED儿童的行为保健服务使用和支出。患有严重SED的孩子由于其症状的严重程度和无法访问替代基于社区的行为保健。减少公共金融伯恩斯和家人与使用精神病学LTC相关的困扰，五分之一的州提供1915（c）HCBS Medicaid Waister 政策。这些政策扩大了由医疗补助资助的社区服务阵列无论家庭收入水平如何，对机构精神病护理的临床需求。尽管这些政策是旨在通过提供替代性社区支持，实现这些替代的精神病学LTC的使用目标尚不清楚。现有研究很少缺乏因果推断或普遍性，因为它们是交叉的对计划参与者的临床变异的部分，区域或最小控制。这个K01的目标是培训接收者，以研究健康政策对卫生政策的影响所需的统计和方法学技能具有复杂行为健康需求的儿童和青少年的服务利用和支出成果。研究目的是1）创建一个全面的SED Waister政策数据集，该数据集将结构和这些政策的规定跨州和随着时间的流逝，2）确定和比较儿童的特征参加了在医疗补助注册的儿童中使用精神病学LTC的儿童参加SED Waister计划和行为健康障碍； 2b）评估策略和瓦斯特计划的注册协会与改善LTC的不利危险因素，3）估计得克萨斯州SED豁免及其影响医疗补助赔偿的行为卫生服务使用和支出的特征。培训目的该项目是1）获得公共卫生法研究方法中的知识，技能和经验，2）建造有关研究设计的假设和适用性的知识和估计统计方法的知识行为健康政策干预措施使用观察和行政数据的因果影响，3）适用使用和衡量行为健康服务使用和支出的当前和最佳实践健康索赔数据的各种来源和4）获得研究，写作和行政专业知识在K01的最后一年提交成功的R01赠款。培训目标将通过正式的课程工作，个性化的指导，开创性和工作组参与，指导研究以及会议参与。研究目的将使用与国家SED豁免申请合并的数据医疗补助索赔来自州和联邦资源的数据。该项目将为全国政策制定者关于哪些儿童可能有精神病学，政策或可能会降低这些风险的服务干预措施，以及这些干预措施可能与这些干预措施相关的费用。