COVID-19 Pandemic-related Changes in the Child Tax Credit and Effects on Behavioral Health for Medicaid-enrolled Adolescents

摘要 青少年的行为健康在COVID-19大流行之前就已经处于危机之中，而且只会恶化。 2021年儿童税收抵免（CTC）的流行病相关变化为弱势群体提供了财政救济 家庭这些变化是历史性的;每个孩子的可退还信贷额增加了一倍多， 没有收入或收入很低的人不再被排除在外，一半的信贷是通过每月预付的方式支付的。 付款（2021年7月至12月）。家庭收入增加是影响健康的一个可以改变的社会决定因素， 可以通过减少家庭压力来改善青少年的心理健康。我们假设， 对于年龄不符合CTC资格的青少年，年龄符合CTC资格的额外CTC预付款 青少年将降低他们发生不良行为健康事件的风险。我们还期望反恐委员会提供 为患有重度抑郁症（MDD）的弱势青少年提供资源，使其能够继续接受治疗。 拟议研究的目标是审查儿童信托基金预付款对青少年的影响， 行为健康和治疗的参与，通过创新，准实验设计（差异， 差异，DID）和并发混合方法。对于目标1，DID将比较之前的效果， 在CTC预付款期间（2021年1月至2021年6月、2021年7月至2021年12月和2022年1月至2022年9月）和之后， 两个年龄组别：1）于2021年第四季年满18岁的青少年（不符合2021年提早领取中央公积金的资格 付款），以及2）2022年第一季度年满18岁的青少年（合格）。我们将使用两个数据源， 从州和国家的角度进行这些分析：1）俄亥俄州Medicaid ACO（n= 10，521），和2） 国家医疗补助T-MSIS分析文件（n= 972，000）。我们的目标1结果包括a）不良行为 紧急情况下的健康事件（故意自残、精神危机、酒精/药物中毒） 科室/住院环境和死亡率（自杀，全因）;和B）门诊治疗和 药物治疗持续（MDD青少年）。至于目标2，我们会招募有以下条件的青少年： 使用定量俄亥俄州医疗补助索赔数据的目的抽样诊断MDD及其护理人员 定性访谈（n=90）。访谈将探讨CTC对家庭财务困境的影响， 家庭资源，青少年行为健康和治疗参与的不同观点 （少数民族和农村居民）。最后，目标3将探索CTC治疗的异质性 对少数民族和农村居民的影响。我们的研究结果的有效性将通过使用 多个数据源和并发的混合方法，包括不同的观点， 我们的利益相关者咨询小组的国家和州政策专家的定性访谈和投入， 以社区为基础的服务提供者，青少年行为健康提供者，以及生活在 体验.冲击我们的研究结果将对反贫困政策的影响产生重要影响， 这是一项针对弱势青少年的心理健康问题的研究，可以为日益严重的心理健康危机提供解决方案。

ABSTRACT Adolescent behavioral health was already in crisis prior to the COVID-19 pandemic and has only worsened. Pandemic-related changes to the 2021 Child Tax Credit (CTC) offered financial relief to disadvantaged families. The changes were historic; the amount of refundable credit per child more than doubled, families with no or very low income were no longer excluded, and half the credit was paid through advance monthly payments (July-December 2021). Increased household income is a modifiable social determinant of health that could improve adolescent mental health through reduced household stressors. We hypothesize that compared to adolescents who were not age-eligible for the CTC, the additional CTC advance payments for age-eligible adolescents will lower their risk for adverse behavioral health events. We also expect that the CTC provided enabling resources for vulnerable adolescents with major depressive disorders (MDD) to continue treatment. The goals of the proposed study are to examine the effects of the CTC advance payments on adolescent behavioral health and treatment engagement through an innovative, quasi-experimental design (difference-in- differences, DID) and concurrent mixed-methods approach. For Aim 1, DID will compare effects before, during, and after the CTC advance payment period (1/2021-6/2021, 7/2021-12/2021, and 1/2022-9/2022) for two age groups: 1) adolescents who turned 18 fourth quarter of 2021 (not eligible for 2021 CTC advance payment), and 2) adolescents who turned 18 first quarter of 2022 (eligible). We will use two data sources to conduct these analyses from a state and national perspective: 1) Ohio Medicaid ACO (n=10,521), and 2) national Medicaid T-MSIS Analytic Files (n=972,000). Our Aim 1 outcomes include a) adverse behavioral health events (deliberate self-harm, psychiatric crisis, alcohol/drug poisoning) in emergency department/inpatient setting, and mortality (suicide, all-cause); and b) outpatient treatment and pharmacotherapy continuation (among adolescents with MDD). For Aim 2, we will recruit adolescents with a diagnosis of MDD and their caregivers using purposive sampling with quantitative Ohio Medicaid claims data for qualitative interviews (n=90). Interviews will explore the influence of the CTC on family financial distress, household resources, adolescent behavioral health and treatment engagement from diverse perspectives (racial/ethnic minorities and rural residents). Finally, Aim 3 will explore heterogeneity of the CTC treatment effects for racial/ethnic minorities and rural residents. The validity of our findings will be strengthened by using multiple data sources and a concurrent mixed-methods approach, including diverse perspectives from qualitative interviews and input from our stakeholder advisory group of national and state policy experts, community-based service providers, adolescent behavioral health providers, and families with lived experience. Impact. Our findings will have important implications for the effects of anti-poverty policies on mental health among vulnerable adolescents and could point to solutions for a growing mental health crisis.