Ethnic Minority Children in Public Mental Health

说明(由申请人提供)：成年人在获得精神卫生保健的机会和质量方面存在种族/族裔差异，这一点得到了很好的证明。类似的差异影响到少数族裔儿童和青年。这项拟议的研究试图记录少数族裔-白人在精神危机护理方面的差异，并将其解释为反映了获得社区服务的差异。它采用横断面、纵向(1998-2001)的视角，对负责加州种族多元化州的医疗补助精神卫生服务的57个自治县级精神卫生项目进行了研究。具体问题是：根据基于医院的危机稳定和基于诊所的危机干预访问，非洲裔、拉丁裔和亚裔美国儿童和青少年是否比白人经历了更多与危机相关的护理？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，即寄养儿童的安置及其相关的精神健康问题监测和转介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。主要数据从州-县年度合同和合规审查中收集和编码。数据被组织为嵌入县系统的客户一级观察，在三年期间每年观察。我们建立客户层面的民族差异在危机使用中的模型，并通过使用固定效应或通过直接指定县特征来消除任何令人困惑的县级差异，当它们在纵向和横向上变化时。衡量危机护理使用的两种类型--危机稳定和干预--的因变量在单独的模型中被指定为任何使用的概率(0，1)，如果使用，则为使用的水平(就诊次数)。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。我们通过输入寄养类别变量并观察它们对种族变量系数的影响来评估危机护理使用、种族和寄养状况之间的关系。类似地，我们测试了客户的门诊/联系经纪使用对危机护理使用的种族差异的影响。

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.