STRENGTHENING MEDICAID-FUNDED MENTAL HEALTH COVERAGE FOR CHILDREN IN CHILD WELFAR

简介（由申请人提供）：摘要儿童福利系统中的儿童享有医疗补助的权利，并且他们的心理健康需求是最昂贵的保险。尽管知道这些孩子的保险成本很高，但医疗补助机构在以下方面几乎没有经验政策指导：哪些儿童特征与支出有关，这些支出在福利体系中的持续时间内的规模如何，以及医疗补助政策在控制成本的同时确保获得服务的效果。这种信息缺失导致医疗补助预算是根据权宜之计而不是适当性来确定的，这影响了医疗补助机构减少受虐待儿童心理健康不平等的能力。在儿童福利研究领域，这个研究小组的成员第一次汇集了一个独特的数据集，将与儿童福利机构接触的儿童的全国调查（全国儿童和青少年福利调查[NSCAW]）的受访者与他们的医疗补助申请数据（医疗补助分析摘录）联系起来。以及他们居住的县的医疗补助和心理健康政策的信息（来自儿童福利机构的照顾儿童）。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。县级政策信息允许检查医疗补助政策在管理支出方面的有效性，同时控制需求。对这一独特构建的数据集进行纵向数据分析将(1)建立儿童需求的各个领域与儿童层面的精神卫生服务利用和支出之间的关系模型；(2)估计儿童发展周期（0- 18岁）的心理卫生服务利用和支出轨迹；(3)研究针对儿童福利的医疗补助政策对心理健康服务利用和支出的影响，以及使用和支出轨迹。这些具体目标与人权理事会的若干供资优先事项相一致，其中包括儿童健康保险研究倡议、将儿童作为重点人群的战略计划以及人权理事会对低收入人群和消除差距的重视。这一申请由一位新的研究者——前AHRQ论文受助人——汇集了一个经验丰富的高级研究者团队和一个州医疗补助政策制定者，在精神病学、儿童福利和心理健康服务研究、健康和心理健康经济学和计量经济学以及医疗补助索赔数据分析方面具有相当大的集体研究和实践专业知识，以回答这些高度脆弱人群的突出问题。

DESCRIPTION (provided by applicant): Abstract Children in the child welfare system possess entitlements to Medicaid, and are the most expensive to insure for their mental health needs. Despite knowing that these children are expensive to insure, Medicaid agencies have little empirical policy guidance on what child characteristics are associated with expenditures, what the magnitude of these expenditures are over the duration of their stay in the welfare system, and the effects of Medicaid policies that can assure access to services while containing costs. This information deficit has resulted in Medicaid budgets being determined on the basis of expediency rather than appropriateness, and this has affected the ability of Medicaid agencies to reduce mental health inequalities among maltreated children. 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 coming into contact with child welfare agencies (National Survey of Child and Adolescent Well-Being [NSCAW]) to their Medicaid claims data (Medicaid Analytic Extract), along with information on Medicaid and mental health policies within their counties of residence (from the Caring for Children in Child Welfare [CCCW]). 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 use and expenditure information contained in claims data. County- level information about policies allows the examination of the effectiveness of Medicaid policies in managing expenditures, while controlling for need. Longitudinal data analysis on this uniquely constructed data set will (1) model relationships between various domains of child need, and child-level mental health service utilization and expenditures among NSCAW children; (2) estimate mental health service utilization and expenditure trajectories over the childhood development cycle (ages 0- 18); and (3) examine effectiveness of Medicaid policies targeted at children in child welfare on mental health service utilization and expenditures, and use and expenditure trajectories. These specific aims are consonant with several of AHRQ's funding priorities, including the Child Health Insurance Research Initiative, the Strategic Plan that focuses on children as a priority population, and AHRQ's emphasis on low-income populations and on the elimination of disparities. This application by a new investigator - a former AHRQ dissertation grantee - brings together a highly experienced team of senior investigators and a state Medicaid policymaker, with considerable collective research and practice expertise in psychiatry, child welfare and mental health services research, health and mental health economics and econometrics, and Medicaid claims data analysis to answer these salient questions for a highly vulnerable population. PUBLIC HEALTH RELEVANCE: The mental health consequences of child maltreatment make children in the child welfare system the nation's principal public mental health problem when it comes to children. The burden of financing such care falls upon Medicaid agencies, which have little information on what child and contextual characteristics are associated with increased service use, and what policies can promote desirable child mental health outcomes. This study uses a uniquely constructed data set to model relationships between child characteristics and Medicaid expenditures, the amount of expenditures throughout the childhood development cycle among these children, and the effects of public policies that can serve Medicaid's access and quality agendas for this highly vulnerable population.