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

项目摘要 此K01应用程序的总体目标是估计1915年（c）家庭和社区为基础的 严重情绪障碍儿童（SED）的医疗补助豁免计划 行为卫生保健服务的使用和支出的儿童与SED。患有严重SED的儿童在 由于其症状的严重性和无法治疗， 获得基于社区的替代性行为健康护理。减轻公共财政负担和家庭负担， 与使用精神病LTC相关的痛苦，五分之一的州提供1915（c）HCBS医疗补助豁免 施政纲要而这些政策扩大了医疗补助资助的以社区为基础的服务阵列，为那些表现出 无论家庭收入水平如何，对精神病机构护理的临床需求。虽然这些政策是 旨在通过提供替代社区支持来防止精神病LTC的使用，实现这些目标 目标不明确。现有的研究很少缺乏因果推理或概括性，因为它们是交叉的。 部门、区域或最低限度地控制项目参与者的临床变异。K01的目标是 培训受援者掌握研究卫生政策对以下方面影响所需的统计和方法技能： 有复杂行为健康需求的儿童和青少年的服务利用和支出结果。 研究目标是：1）创建一个全面的SED豁免政策数据集，将结构编入法典， 这些政策的规定在各州和一段时间内，2）确定和比较儿童的特点 参加SED豁免计划的儿童和使用精神科LTC的儿童， 行为健康障碍; 2b）评估SED豁免政策和豁免计划注册与 改善LTC的不利风险因素，以及3）评估德克萨斯州SED豁免及其 医疗补助报销的行为健康服务使用和支出的特点。培训目标 这些项目是：1）获得公共卫生法研究方法知识、技能和经验，2）建立 了解研究设计和统计方法的假设和适用性， 使用观察和管理数据的行为健康政策干预的因果效应，3）应用 定义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，写作和管理专业知识， 在K01的最后一年提交成功的R01赠款。培训目标将通过 正式课程，个性化教学，研讨会和研讨会的参与，指导研究，和 会议参与。研究目标将使用来自州SED豁免申请的数据， 医疗补助计划声称数据来自州和联邦资源。该项目将提供新的证据， 关于哪些儿童可能面临精神病院护理的风险， 可能降低这些风险的服务干预措施，以及与这些干预措施相关的成本。

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.