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

描述（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，并且为满足其心理健康需求提供最昂贵的保险。尽管知道这些儿童的保险费用很高，但医疗补助机构对于哪些儿童特征与支出相关、这些支出在他们留在福利系统期间的规模以及医疗补助政策在确保获得服务的同时控制成本的效果方面缺乏实证政策指导。这种信息缺乏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，该研究团队的成员首次收集了一个独特的数据集，该数据集将全国儿童与儿童福利机构接触儿童调查（全国儿童和青少年福祉调查 [NSCAW]）的受访者与他们的医疗补助索赔数据（医疗补助分析摘录）以及其居住县内的医疗补助和心理健康政策信息（来自儿童福利机构中的儿童关怀组织 [CCCW]）联系起来。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措施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。县级有关政策的信息可以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) 对 NSCAW 儿童中儿童需求的各个领域以及儿童层面的心理健康服务利用和支出之间的关系进行建模； (2) 估计儿童发展周期（0-18 岁）的心理健康服务利用率和支出轨迹； (3) 审查针对儿童福利中的儿童的医疗补助政策在心理健康服务利用和支出以及使用和支出轨迹方面的有效性。这些具体目标与 AHRQ 的多项资助优先事项相一致，包括儿童健康保险研究计划、将儿童作为重点人群的战略计划，以及 AHRQ 对低收入人群和消除不平等的重视。这项申请由一位新研究者（前 AHRQ 论文受资助者）提出，汇集了经验丰富的高级研究者团队和州医疗补助政策制定者，他们在精神病学、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拥有大量的集体研究和实践专业知识，旨在回答高度弱势群体的这些突出问题。 公共健康相关性：虐待儿童造成的心理健康后果使儿童福利系统中的儿童成为国家儿童的主要公共心理健康问题。为此类护理提供资金的负担落在医疗补助机构身上，这些机构对哪些儿童和背景特征与服务使用增加相关以及哪些政策可以促进理想的儿童心理健康结果知之甚少。本研究使用独特构建的数据集来模拟儿童特征与医疗补助支出之间的关系、这些儿童整个儿童发展周期的支出金额，以及可以为这一高度弱势群体提供医疗补助准入和质量议程的公共政策的影响。

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.