WELFARE REFORM & USE OF MENTAL HEALTH SERVICES BY WOMEN

越来越多的人认识到，一部分领取福利的妇女在工作和自给自足方面面临着多重障碍。福利改革的后果很可能对患有精神健康和/或药物滥用相关障碍的女性户主这一群体产生极端负面的影响。特别是，由于目前的福利改革，这一高危人群获得服务的机会可能会受到威胁。这就引出了一个关键的经验性问题：精神卫生服务提供系统将如何适应这一高危人群的需求？充分了解影响贫困妇女使用行为健康服务的使用模式的因素，对于制定影响贫困妇女使用行为健康服务的使用模式的战略至关重要，对于制定战略，影响政策变化对这一高危人群获得服务的影响至关重要。这项提案涉及一项研究的第一阶段，该研究将开发一个纵向数据库和多元研究方法，以审查有资格获得医疗补助的贫困妇女目标人口的心理健康和药物滥用护理模式的变化，这些模式历来是根据接受抚养子女家庭援助(AFDC)，现在是接受贫困家庭临时援助(TANF)。这项研究将实现两个相互关联的目标：(1)了解哪些因素可以解释接受医疗补助、心理健康和药物滥用服务的贫困妇女户主的护理模式；(2)提供信息，指导在重大社会福利和卫生政策重新制定后，制定干预战略，以改善这些高危人群获得心理健康服务的机会和质量。这项研究符合一个更大的、长期的研究议程，重点是提供有关这些政策改革对有心理健康需求的女性户主的生活的影响的信息，以及为改善这一福利群体的结果而必须进行的心理健康和更大规模的公共服务系统改革的信息。医疗补助报销数据将与行政数据相结合，分析研究人群的使用模式，包括系统和服务接受者的特征。将解决以下研究问题。1.这一群体的护理模式是什么(描述性)；以及2.哪些客户和系统特征解释了护理模式(解释性)？

There is increasing recognition that a subset of women on welfare face multiple barriers to work and self-sufficiency. The consequences of welfare reform are likely to be extremely negative for the subpopulation of women heads-of-households with mental health and/or substance abuse related disorders. In particular, access to services by this at-risk population may be in jeopardy as a consequence of current welfare reforms. This begs a critical empirical question: How will the mental health service delivery system accommodate the needs of this at-risk population? Adequately understanding the forces affecting the utilization patterns of poor women using behavioral health services is critical for developing strategies to influence the utilization patterns of poor women using behavioral health services is critical for developing strategies to influence the impact of policy changes on access to services by this at risk population. This proposal deals with phase one of a study that will develop a longitudinal database and multivariate research methodology to examine changes to patterns of mental health and substance abuse care for the target population of poor women eligible for Medicaid based historically on receipt of Aid to Families with Dependent Children (AFDC), and now Temporary Assistance for Needy Families (TANF). The study will accomplish two interrelated objectives: (1) Provide an understanding of what factors explain the patterns of care of poor women heads-of-households receiving Medicaid mental health and substance abuse services; and (2) provide information to guide development of intervention strategies to improve access to and quality of mental health services for this at risk population, in the wake of major social welfare and health policy reformulation. This research fits into a larger, long term research agenda focused on providing information about both the impact of these policy reforms on the lives of women heads-of-households with mental health needs, and the mental health and larger human service system changes that must be undertaken to improve outcomes for this subset of the welfare population. Medicaid claims data will be combined with administrative data in an analysis of utilization patterns of the study population, including both system and service recipient characteristics. The following research questions will be addressed. 1. What are the patterns of care of this population (descriptive); and 2. What client and systems characteristics explain the patterns of care (explanatory)?