Securing Standards-Consistent Mental Health Care for Children in Child Welfare

描述(申请人提供)：虽然儿童福利系统中的儿童是心理健康服务的最高儿童使用者之一，但人们对他们所接受的服务的质量知之甚少。目前，美国儿童福利联盟(CWLA)、美国儿科学会(AAP)和美国儿童与青少年精神病学协会(AACAP)提出了针对这些儿童的心理健康护理国家标准。然而，在儿童一级，没有关于儿童福利系统中的儿童在多大程度上得到符合这些国家标准的照顾的信息。一位新的调查员进行的这项研究利用了该国第一份关于接触儿童福利机构的具有全国代表性的小组研究--全国儿童和青少年福祉调查(NSCAW)--来检查儿童福利系统中的儿童在多大程度上实际得到了符合国家标准的照顾。NSCAW与NIMH资助的县级政策伙伴研究--儿童福利中的儿童关爱研究--相联系，提供了审查卫生筹资政策对符合这些标准的护理的影响的能力。这项研究将使用这些数据集进行多层次分析，以便(1)确定与全国儿童福利机构接触的儿童的特征，这些儿童最有可能接受不符合国家标准的护理；(2)确定影响获得符合国家标准的护理的医疗补助覆盖范围的个人层面的缺陷(主要是随着时间的推移，医疗补助覆盖范围的中断)；以及(3)确定与接受符合国家标准的护理正相关的县级医疗补助政策。这些具体目标与NIMH计划公告(PA-07-213)：精神健康经济学研究，以及医学研究所最近题为《提高精神和物质使用条件的医疗保健质量》的研究方向建议是一致的，该报告呼吁使用竞争性保险机制来利用高质量的医疗保健。为贫困人口提供稳定的医疗保险是公共卫生的一项政策优先事项，而儿童福利系统中的儿童是心理健康需求很高的特别脆弱的人群。这项研究考察了医疗补助覆盖范围对这些儿童在全国范围内获得高质量心理健康服务的影响。

DESCRIPTION (provided by applicant): Although children in the child welfare system are among the highest child users of mental health services, little is known about the quality of the services they receive. Currently, there exist national standards of mental health care for these children proposed by the Child Welfare League of America (CWLA), the American Academy of Pediatrics (AAP), and the American Association of Child and Adolescent Psychiatry (AACAP). However, there is no information at the child-level on the extent to which children in the child welfare system receive care that is consistent with these national standards. This study by a new investigator takes advantage of the availability of the country's first nationally representative panel study of children coming into contact with child welfare agencies - the National Survey of Child and Adolescent Well-Being (NSCAW) - to examine the extent to which children in the child welfare system actually receive care consistent with national standards. The linkage of NSCAW to an NIMH-funded companion study of county-level policies - the Caring for Children in Child Welfare study - offers the ability to examine the impact of health financing policies on care consistent with these standards. This study will conduct multilevel analysis using these datasets in order to (1) identify the characteristics of Medicaid- enrolled children coming into contact with child welfare agencies nationwide who are at most risk for not receiving care consistent with national standards; (2) identify individual-level deficiencies in Medicaid coverage (primarily discontinuity of Medicaid coverage over time) that affect receipt of care consistent with national standards; and (3) identify county-level Medicaid policies positively associated with receipt of care consistent with national standards. These specific aims are consistent with the research direction recommendations of the NIMH Program Announcement (PA-07-213): Research on Mental Health Economics, as well as the recent Institute of Medicine report titled Improving the Quality of Health Care for Mental and Substance-Use Conditions calling for the use of competitive insurance mechanisms to leverage high-quality care. Providing stable health insurance to needy populations is a policy priority for public health, and children in the child welfare system are a particularly vulnerable population with high mental health needs. This study examines the effects of Medicaid coverage on access to high-quality mental health services among a national sample of these children.