Reducing Disparities in Mental Health Expenditure Among Children in Child Welfare

描述（由申请人提供）：与儿童福利机构接触的儿童构成了被描述为儿童方面主要的公共心理健康问题。这大约580万儿童不成比例地是非白人，在利用心理健康服务方面表现出相当大的种族/族裔差异。使这些差异尤其有害的是，几乎所有这些孩子都有权享受医疗补助。由于缺乏导致不同种族/族裔儿童对服务的不同利用的因素的信息，医疗补助机构减少其受益人之间发生的这些差异的能力受到了阻碍，这可能会导致这一高度弱势群体的心理健康状况恶化。这是儿童福利研究领域的第一次，该研究小组的成员正在收集一个独特的数据集，将儿童福利儿童全国调查的受访者与其医疗补助申请数据联系起来，以及他们居住的县的医疗补助和心理健康政策信息。这种联系将调查数据中包含的丰富的个人信息——例如使用标准化心理测量方法确定的心理健康服务需求——与索赔数据中包含的使用和支出信息结合起来。在本研究中，我们建议完成该数据集的构建，然后进行纵向数据分析：(1)在全国儿童福利样本中，模拟心理健康服务利用（门诊心理健康服务使用、住院住院、精神药物使用、总体服务量和服务及时性）和支出的种族/民族差异；(2)估计这些儿童在儿童发育周期（0- 18岁）中心理卫生服务利用和支出轨迹的种族/民族差异；(3)检查符合国家标准的护理作为这些儿童在心理卫生服务利用和支出（来自目标1）以及使用和支出轨迹（来自目标2）方面的种族/民族差异的中介的作用；(4)医疗补助政策（假定资格、管理护理和系统协调）对心理健康服务利用和支出（来自目标1）以及使用和支出轨迹（来自目标2）的种族/民族差异的影响；这项由一名新调查员提出的建议汇集了一个经验丰富的高级调查员团队和一名州医疗补助政策制定者，以解决这些关于医疗补助覆盖非常脆弱的儿童群体的突出问题。该提案与联邦和NIH的几个优先事项保持一致，包括NIMH战略计划，外科医生的几份报告，医学研究所的出版物，以及健康人2020的几个拟议目标，所有这些都要求采取政策行动，减少和消除心理健康方面的差距。

DESCRIPTION (provided by applicant): Children coming into contact with child welfare agencies constitute what has been described as the dominant public mental health problem when it comes to children. These approximately 5.8 million children are disproportionately non-white, and display considerable race/ethnic disparities in their utilization of mental health services. What makes these disparities especially pernicious is that virtually all of these children have entitlements to Medicaid. Medicaid agencies' ability to reduce these disparities occurring among its beneficiaries is hampered by the lack of information on what factors result in differential utilization of services among children of different race/ethnicities, which has the potential risk of worsening mental health outcomes among this highly vulnerable population. For the first time in the field of child welfare research, members of this research team are assembling a unique data set that links the respondents of a national survey of children in child welfare to their Medicaid claims data, along with information on Medicaid and mental health policies within their counties of residence. Such a linkage combines the richness of person-level information contained in survey data - such as need for mental health services identified using standardized psychometric measures - with the use and expenditure information contained in claims data. In the present study, we propose to complete construction of this data set, and then conduct longitudinal data analysis to (1) model race/ethnic differences in mental health service utilization (ambulatory mental health service use, inpatient hospitalizations, psychotropic medication use, overall service volume, and timeliness of services) and expenditures among a national sample of children in child welfare; (2) estimate race/ethnic differences in mental health services utilization and expenditure trajectories over the childhood development cycle (ages 0- 18 years) among these children; and (3) examine the role of care consistent with national standards as mediators of race/ethnic differences in mental health service utilization and expenditures (from Aim 1), and use and expenditure trajectories (from Aim 2), among these children; and (4) effects of Medicaid policies (presumptive eligibility, managed care, and system coordination) on race/ethnic differences in mental health service utilization and expenditures (from Aim 1), and use and expenditure trajectories (from Aim 2), among these children This proposal by a new investigator brings together a highly experienced team of senior investigators and a state Medicaid policymaker to address these salient issues with respect to Medicaid coverage of a very vulnerable child population. This proposal is aligned to several Federal and NIH priorities, including the NIMH Strategic Plan, several reports of the Surgeon-General, publications from the Institute of Medicine, and several of the proposed objectives from Healthy People 2020, all of which call for policy action that can reduce and eliminate disparities in mental health.