Reducing Disparities in Mental Health Expenditure Among Children in Child Welfare

减少儿童福利中儿童心理健康支出的差异

基本信息

  • 批准号:
    8114568
  • 负责人:
  • 金额:
    $ 30.36万
  • 依托单位:
  • 依托单位国家:
    美国
  • 项目类别:
  • 财政年份:
    2011
  • 资助国家:
    美国
  • 起止时间:
    2011-05-16 至 2014-03-31
  • 项目状态:
    已结题

项目摘要

DESCRIPTION (provided by applicant): Children coming into contact with child welfare agencies constitute what has been described as the dominant public mental health problem when it comes to children. These approximately 5.8 million children are disproportionately non-white, and display considerable race/ethnic disparities in their utilization of mental health services. What makes these disparities especially pernicious is that virtually all of these children have entitlements to Medicaid. Medicaid agencies' ability to reduce these disparities occurring among its beneficiaries is hampered by the lack of information on what factors result in differential utilization of services among children of different race/ethnicities, which has the potential risk of worsening mental health outcomes among this highly vulnerable population. 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 in child welfare to their Medicaid claims data, along with information on Medicaid and mental health policies within their counties of residence. 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 the use and expenditure information contained in claims data. In the present study, we propose to complete construction of this data set, and then conduct longitudinal data analysis to (1) model race/ethnic differences in mental health service utilization (ambulatory mental health service use, inpatient hospitalizations, psychotropic medication use, overall service volume, and timeliness of services) and expenditures among a national sample of children in child welfare; (2) estimate race/ethnic differences in mental health services utilization and expenditure trajectories over the childhood development cycle (ages 0- 18 years) among these children; and (3) examine the role of care consistent with national standards as mediators of race/ethnic differences in mental health service utilization and expenditures (from Aim 1), and use and expenditure trajectories (from Aim 2), among these children; and (4) effects of Medicaid policies (presumptive eligibility, managed care, and system coordination) on race/ethnic differences in mental health service utilization and expenditures (from Aim 1), and use and expenditure trajectories (from Aim 2), among these children This proposal by a new investigator brings together a highly experienced team of senior investigators and a state Medicaid policymaker to address these salient issues with respect to Medicaid coverage of a very vulnerable child population. This proposal is aligned to several Federal and NIH priorities, including the NIMH Strategic Plan, several reports of the Surgeon-General, publications from the Institute of Medicine, and several of the proposed objectives from Healthy People 2020, all of which call for policy action that can reduce and eliminate disparities in mental health. PUBLIC HEALTH RELEVANCE: Race/ethnic disparities in access to needed mental health services is a national public health concern, highlighted in several publications from the Institute of Medicine, the Surgeon-General, and Healthy People 2020 objectives. These disparities are especially prevalent among children in the child welfare system, a group with the highest needs for mental health services among child populations, and a group that paradoxically possesses entitlements to Medicaid. Clearly, Medicaid agencies require better information on the magnitude of these disparities both cross-sectionally and over time, as well as an investigation of which Medicaid policies may worsen disparities among this vulnerable population. For the first time in child welfare research, this study links national survey data of children in child welfare with Medicaid claims data to identify, quantify, and appropriately resource care for children at risk for disparities in access to services. In the context of health reform, this proposal provides a unique opportunity to examine how disparities among these children can be reduced through Medicaid policy action.
描述(由申请人提供):与儿童福利机构接触的儿童构成了被描述为儿童的主要公共心理健康问题。这大约580万儿童中非白人儿童所占比例过高,在利用心理健康服务方面表现出相当大的种族/族裔差异。使这些差异特别有害的是,几乎所有这些儿童都有权享受医疗补助。医疗补助机构减少其受益人之间发生的这些差异的能力受到阻碍,因为缺乏关于导致不同种族/民族儿童之间服务利用差异的因素的信息,这有可能使这一高度脆弱人群的心理健康结果恶化。 在儿童福利研究领域,该研究小组的成员第一次收集了一个独特的数据集,将全国儿童福利调查的受访者与他们的医疗补助索赔数据联系起来,沿着他们居住县内的医疗补助和心理健康政策信息。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。在本研究中,我们建议完成该数据集的构建,然后进行纵向数据分析,以(1)建立精神卫生服务利用的种族/民族差异模型(门诊精神卫生服务使用、住院治疗、精神药物使用、总体服务量和服务及时性)和支出;(2)估计儿童发育周期内心理健康服务利用和支出轨迹的种族/民族差异(0- 18岁);以及(3)检查与国家标准一致的护理作为精神卫生服务利用和支出中种族/民族差异的调解人的作用(来自目标1),以及使用和支出轨迹(目标2),在这些儿童中;(4)医疗补助政策的影响(假定资格,管理式护理和系统协调)对精神卫生服务利用和支出的种族/民族差异的影响(来自目标1),以及使用和支出轨迹(目标2),这项由一位新调查员提出的建议汇集了一个经验丰富的高级调查员团队和一位州医疗补助政策制定者,以解决这些突出的问题。关于医疗补助覆盖非常脆弱的儿童群体的问题。该提案与几个联邦和NIH的优先事项相一致,包括NIMH战略计划,外科医生的几份报告,医学研究所的出版物,以及2020年健康人的几个拟议目标,所有这些都要求采取政策行动,以减少和消除心理健康方面的差距。 公共卫生相关性:获得所需心理健康服务方面的种族/民族差异是一个国家公共卫生问题,医学研究所、卫生局局长和2020年健康人目标的多份出版物都强调了这一点。这些差异在儿童福利系统中的儿童中尤其普遍,这是儿童人口中对心理健康服务需求最高的群体,也是一个矛盾的群体,他们有权获得医疗补助。显然,医疗补助机构需要更好的信息,这些差距的大小都跨部门和随着时间的推移,以及调查哪些医疗补助政策可能会加剧这一弱势群体之间的差距。在儿童福利研究中,这项研究首次将儿童福利中儿童的全国调查数据与医疗补助索赔数据联系起来,以确定,量化和适当的资源护理儿童在获得服务方面存在差异。在卫生改革的背景下,这一建议提供了一个独特的机会,研究如何通过医疗补助政策行动减少这些儿童之间的差距。

项目成果

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Ramesh Raghavan其他文献

Ramesh Raghavan的其他文献

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{{ truncateString('Ramesh Raghavan', 18)}}的其他基金

Reducing Disparities in Mental Health Expenditure Among Children in Child Welfare
减少儿童福利中儿童心理健康支出的差异
  • 批准号:
    8452586
  • 财政年份:
    2011
  • 资助金额:
    $ 30.36万
  • 项目类别:
STRENGTHENING MEDICAID-FUNDED MENTAL HEALTH COVERAGE FOR CHILDREN IN CHILD WELFAR
加强医疗补助资助的儿童心理健康覆盖范围
  • 批准号:
    8512678
  • 财政年份:
    2011
  • 资助金额:
    $ 30.36万
  • 项目类别:
Reducing Disparities in Mental Health Expenditure Among Children in Child Welfare
减少儿童福利中儿童心理健康支出的差异
  • 批准号:
    8263964
  • 财政年份:
    2011
  • 资助金额:
    $ 30.36万
  • 项目类别:
STRENGTHENING MEDICAID-FUNDED MENTAL HEALTH COVERAGE FOR CHILDREN IN CHILD WELFAR
加强医疗补助资助的儿童心理健康覆盖范围
  • 批准号:
    8084560
  • 财政年份:
    2011
  • 资助金额:
    $ 30.36万
  • 项目类别:
STRENGTHENING MEDICAID-FUNDED MENTAL HEALTH COVERAGE FOR CHILDREN IN CHILD WELFAR
加强医疗补助资助的儿童心理健康覆盖范围
  • 批准号:
    8335166
  • 财政年份:
    2011
  • 资助金额:
    $ 30.36万
  • 项目类别:
Securing Standards-Consistent Mental Health Care for Children in Child Welfare
确保儿童福利中儿童心理健康护理符合标准
  • 批准号:
    7561001
  • 财政年份:
    2008
  • 资助金额:
    $ 30.36万
  • 项目类别:
GWB Mental Health Service Research Training
GWB 心理健康服务研究培训
  • 批准号:
    8502359
  • 财政年份:
    1995
  • 资助金额:
    $ 30.36万
  • 项目类别:
GWB Mental Health Service Research Training
GWB 心理健康服务研究培训
  • 批准号:
    8265323
  • 财政年份:
    1995
  • 资助金额:
    $ 30.36万
  • 项目类别:
GWB Mental Health Service Research Training
GWB 心理健康服务研究培训
  • 批准号:
    8697135
  • 财政年份:
    1995
  • 资助金额:
    $ 30.36万
  • 项目类别:

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