Ethnic Minority Children in Public Mental Health

描述（由申请人提供）：在成年人中，在获得精神卫生保健的机会和质量方面的种族/民族差异有充分的记录。平行差异影响少数民族儿童和青少年。这项拟议的研究试图记录少数族裔和白人在精神危机护理方面的差异，并将其解释为获得社区服务的差异。它采用横截面，纵向（1998-2001）的观点，57个自治县级心理健康项目负责医疗补助心理健康服务在种族多元化的加利福尼亚州。具体问题是：非裔美国人、拉丁裔美国人和亚裔美国儿童和青少年是否比白人经历更多的危机相关护理，以医院为基础的危机稳定和诊所为基础的危机干预访问来衡量？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会减少危机护理方面的差异？危机护理中的种族差异是否受到联营经纪和门诊护理使用差异的影响？次要数据来自加州心理健康部门的Medi-Cal索赔文件。主要数据从年度州-县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级观测，每年观测3年。我们建立了危机使用中客户层面种族差异的模型，并通过使用固定效应或通过直接说明县特征（当它们在纵向和横截面上发生变化时）来消除任何令人混淆的县层面差异。因变量，测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，使用的水平（访问次数）。主要自变量是代表客户种族的分类（0,1）变量。族裔系数的大小和方向将揭示危机使用中的族裔差异程度。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、种族和寄养状况之间的关系。同样，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.