Ethnic Minority Children in Public Mental Health

描述（由申请人提供）：成年人在获得精神卫生保健和质量方面存在种族/民族差异。少数群体儿童和青年也受到类似差异的影响。这项拟议的研究旨在记录少数族裔白人在精神病危机护理方面的差异，并将其解释为反映了社区服务的差异。它需要一个横截面，纵向（1998-2001年）的角度来看，57个自治县一级的精神卫生计划负责医疗补助的精神卫生服务，在种族多元化的加州。具体问题如下：非裔美国人，拉丁裔和亚裔美国儿童和青少年经历更多的危机相关的护理比白人，以医院为基础的危机稳定和诊所为基础的危机干预访问？社区儿童在危机护理方面的种族差异是否比寄养儿童更明显，即寄养安置及其相关的心理健康问题监测和转诊是否减少了危机护理方面的差异？危机护理中的种族差异是否受到联系经纪和门诊护理使用差异的影响？次要数据来自加州精神卫生部Medi-Cal索赔文件。主要数据收集和编码从年度州县合同和合规审查。数据被组织为客户一级的观察嵌入在国家系统观察每年超过3年的时间。我们建立模型的客户端层面的种族差异，在危机的使用，并删除任何混淆县一级的变化，通过使用固定的影响，或通过直接规格的县的特点时，他们都有不同的纵向和横截面。因变量，衡量两种类型的危机护理使用-危机稳定和干预-在单独的模型中指定为任何使用的概率（0，1），如果使用，使用水平（访问次数）。主要自变量是代表客户种族的分类（0，1）变量。种族系数的大小和方向将揭示危机使用中的种族差异程度。我们通过输入寄养分类变量并观察其对种族变量系数的影响来评估危机护理使用、种族和寄养状态之间的关系。同样，我们测试的影响，客户的门诊/链接经纪人使用的种族差异，在危机护理使用。

DESCRIPTION (provided by applicant): Racial/ethnic disparities in access and quality of mental health care are well documented among adults. Parallel differences affect minority children and youth. The proposed study seeks to document minority-white disparities in psychiatric crisis care and to explain them as reflecting differential access to community-based services. It takes a cross-sectional, longitudinal (1998-2001) perspective of the 57 autonomous county-level mental health programs responsible for Medicaid mental health services in the ethnically diverse state of California. Specific questions are: Do African American, Latino, and Asian American children and youth experience more crisis-related care than whites as measured by hospital-based crisis stabilization and clinic-based crisis intervention visits? Are ethnic disparities in crisis care more pronounced for children in the community than for those in foster care, i.e. does placement in foster care, with its associated monitoring and referral for mental health problems, decrease disparities in crisis care? Are ethnic disparities in crisis care affected by differences in use of linkage-brokerage and outpatient care? Secondary data come from California Department of Mental Health Medi-Cal claims files. Primary data are collected and coded from annual state-county contracts and compliance reviews. Data are organized as client-level observations embedded within county systems observed annually over the 3-year period. We build models of client-level ethnic disparities in crisis use and remove any confounding county-level variation through the use of fixed effects, or through direct specification of county characteristics when they vary both longitudinally and cross-sectionally. Dependent variables, measuring the two types of crisis care use -- crisis stabilization and intervention -- are specified in separate models as the probability of any use (0, 1), and if used, the level of use (# of visits). Main independent variables are categorical (0, 1) variables representing the client's ethnicity. The magnitude and direction of the ethnicity coefficients will reveal the level of ethnic disparities in crisis use. We assess relationships between crisis care use, ethnicity and foster care status by entering foster care categorical variables and observing their effect on the ethnic variables' coefficients. Similarly, we test the effect of clients' outpatient/linkage-brokerage use on ethnic disparities in crisis care use.