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

与 COVID-19 大流行相关的儿童税收抵免变化及其对参加医疗补助的青少年行为健康的影响

• 批准号: 10686628
• 负责人: Laura Chavez
• 金额: $ 146.43万
• 依托单位: RESEARCH INST NATIONWIDE CHILDREN'S HOSP
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-02 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10686628
• 关键词: Accident and Emergency department; Acute; Address; Adolescent; Affect; Age; Alcohols; Ambulatory Care; Behavior Therapy; Buffers; COVID-19 pandemic; Caregivers; Cessation of life; Child; County; Data; Data Set; Data Sources; Diagnosis; Disadvantaged; Disparity population; Eligibility Determination; Emergency department visit; Enrollment; Event; Exclusion; Family; Financial Hardship; Food; Future; Goals; Health Personnel; Heterogeneity; Household; Housing; Income; Inequity; Injury; Inpatients; Interview; Link; Low income; Major Depressive Disorder; Medicaid; Mental Depression; Mental Health; Mental Health Services; Methods; Ohio; Outcome; Outpatients; Overdose; Parents; Pharmaceutical Preparations; Pharmacotherapy; Poisoning; Policies; Policy Making; Population; Poverty; Premature Mortality; Probability; Problem behavior; Qualifying; Quasi-experiment; Reporting; Resources; Risk; Risk Factors; Rural; Rural Community; Rural Minority; Sampling; Self-Injurious Behavior; Suicide; Taxes; Time; Youth; accountable care organization; adverse outcome; age group; aged; behavioral health; child poverty; community based service; ethnic minority; experience; experimental study; health disparity; high risk; improved; indexing; innovation; medical attention; minority children; mortality; multiple data sources; pandemic disease; payment; protective effect; racial minority; recruit; rural dwellers; service providers; social health determinants; socioeconomic disadvantage; stressor; suicidal risk; tool; treatment effect; trend; urban minority; vulnerable adolescent

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.

摘要 在新冠肺炎大流行之前，青少年行为健康就已经处于危机之中，而且还在恶化。 2021年儿童税收抵免(CTC)与流行病相关的变化为弱势群体提供了经济救济 家人。这些变化是历史性的；每个孩子的可退还信用额度增加了一倍多， 没有收入或非常低的收入不再被排除在外，一半的信贷是按月预付的 付款(2021年7月至12月)。家庭收入增加是健康的一个可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。我们假设相比于 对于没有年龄资格参加反恐公约的青少年，反恐委员会为符合年龄资格的青少年预付额外款项 青少年将降低他们发生不良行为健康事件的风险。我们还期待反恐委员会提供 为患有严重抑郁障碍(MDD)的弱势青少年提供继续治疗的资源。 拟议研究的目标是检查CTC预付款对青少年的影响 通过创新的准实验设计实现行为健康和治疗参与度( DID)和并行混合方法方法。对于目标1，DID将比较以前的效果， 在CTC预付款期间及之后(2021年1月至2021年6月、2021年7月至2021年12月和2022年1月9日) 两个年龄段：1)2021年第四季度满18岁的青少年(没有资格享受2021年CTC预付款 2)2022年第一季度年满18岁的青少年(符合条件)。我们将使用两个数据源来 从州和国家的角度进行这些分析：1)俄亥俄州医疗补助ACO(n=10,521)，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、各种原因)；以及b)门诊治疗和 继续药物治疗(在患有MDD的青少年中)。对于目标2，我们将招募具有以下特征的青少年 利用俄亥俄州定量医疗补助索赔数据的目的抽样诊断MDD及其照顾者 进行定性访谈(n=90)。访谈将探讨CTC对家庭财务困境的影响， 不同视角下的家庭资源、青少年行为健康与治疗参与度 (种族/少数民族和农村居民)。最后，目标3将探索CTC治疗的异质性 对少数族裔和农村居民的影响。我们的发现的有效性将通过使用 多个数据源和并发混合方法方法，包括来自 由国家和州政策专家组成的利益相关者咨询小组的定性访谈和意见， 以社区为基础的服务提供者、青少年行为健康提供者和生活在一起的家庭 经验。冲击力。我们的发现将对反贫困政策的影响产生重要影响 在弱势青少年中的心理健康，并可能为日益严重的心理健康危机指明解决办法。