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拥有医疗补助的权利，并且是最昂贵的，以确保他们的心理健康需求。尽管知道这些儿童是昂贵的保险，医疗补助机构几乎没有经验的政策指导，什么样的儿童特征与支出，这些支出的幅度是在他们留在福利系统的持续时间，以及医疗补助政策的影响，可以确保获得服务，同时控制成本。这种信息不足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，这一研究小组的成员首次收集了一套独特的数据，将一项全国性调查的受访儿童与儿童福利机构联系起来。（全国儿童和青少年健康调查[NSCAW]），以他们的医疗补助索赔数据（Medicaid分析摘录），沿着有关其居住县内的Medicaid和心理健康政策的信息（来自儿童福利中的儿童关怀[CCCW]）。这种联系结合了调查数据中所载的丰富的个人层面信息-例如使用标准化心理测量方法确定的精神卫生服务需求-与索赔数据中所载的使用和支出信息。县一级的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。对这个独特构建的数据集进行纵向数据分析将（1）建立儿童需求各个领域之间的关系模型，以及NSCAW儿童的儿童级心理健康服务利用和支出;（2）估计儿童发育周期内的心理健康服务利用和支出轨迹（0- 18岁）;（3）研究针对儿童福利机构儿童的医疗补助政策对心理健康服务利用和支出的有效性，以及使用和支出轨迹。这些具体目标与美国人权问题咨询委员会的几个供资优先事项相一致，包括儿童健康保险研究倡议、以儿童为重点的战略计划以及美国人权问题咨询委员会对低收入人口和消除不平等的重视。一位新的研究人员-前AHRQ论文授予者-的这一申请汇集了一个经验丰富的高级研究人员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方面具有相当大的集体研究和实践专业知识，医疗补助要求数据分析来回答高度脆弱人群的这些突出问题。 公共卫生相关性：虐待儿童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福尔斯在了医疗补助机构身上，这些机构对哪些儿童和背景特征与服务使用的增加相关，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。这项研究使用了一个独特的构建数据集来模拟儿童特征和医疗补助支出之间的关系，这些儿童在整个儿童发育周期中的支出金额，以及公共政策的影响，这些政策可以为这个高度脆弱的人群提供医疗补助的访问和质量议程。

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.