Policies Improving Non-English Speakers' Access & Care

描述(由申请人提供)：克服与英语水平有限相关的准入障碍--“语言障碍”--有望大大有助于消除在获得专业精神卫生保健方面的差距。自1997年以来，加州精神卫生部门(DMH)要求该州57家县级运营的精神卫生机构，当该县的受益人人数达到“3,000名受益人或主要语言不是英语的Medi-Cal人口的5%(以较低者为准)”的“门槛”水平时，必须以其主要语言向Medicaid(Medi-Cal)受益人提供信息和服务。这项研究将评估加州门槛语言政策要求(TLPR)对19岁-的Medi-Cal受益人在从1997年7月到2003年6月的72个月期间获得和持续护理的影响。具体的研究问题是：1)在非英语国家中，TLPR对获得专门的精神卫生保健和护理的连续性有什么影响？2)TLPR的影响如何被更广泛的努力所取代或补充，以通过雇用双语提供者和提供特定语言的计划来服务非英语人口？使用面板数据回归方法，以县和月为单位和观察期，我们将评估不同语言在获得和连续性护理方面的差异，因为它们与四个TLPR的实施以及双语提供者的雇用和特定语言项目的提供有关。同时，我们将控制县社会人口环境、精神卫生系统的差异，以及说英语的人在机会和连续性方面的变化。分析将使用Medi-Cal专科精神健康索赔数据和从加州DMH获得的Medi-Cal资格数据进行。其他州数据来源将用于衡量县和服务系统的特征。主要数据将从县文化能力计划和州合规审查报告中收集，这些报告记录了每个县实施TLPR的情况，以及双语提供者和特定语言项目的可用性。将由受过培训的双语采访者进行个人深入采访，以了解他们对TLPR和其他县精神卫生活动如何帮助或阻碍获得和持续精神卫生保健的看法。

DESCRIPTION (provided by applicant): Overcoming access barriers associated with limited proficiency in the English language-the "language barrier" - is expected to contribute greatly toward eliminating disparities in access to specialty mental health care. Since 1997, the California Department of Mental Health (DMH) has required that the state's 57 county-operated mental health agencies provide information and services to Medicaid (Medi-Cal) beneficiaries in their primary language when the number of beneficiaries in the county reaches "threshold" levels defined as "3,000 beneficiaries or 5% of the Medi-Cal population, whichever is lower, whose primary language is other than English." This study will assess the impact of California's threshold language policy requirements (TLPRs) on access and continuity of care for Medi-Cal beneficiaries ages 19-64 over a 72- month period beginning July 1997 and ending June 2003. Specific research questions are: 1) Among non-English speakers, what is the impact of TLPRs on access to specialty mental health care and continuity of care? 2) How is the impact of TLPRs substituted or complemented by broader efforts to serve non-English speaking populations through hiring of bilingual providers and provision of language specific programs? Using panel data regression methods, with the county and month as the unit and period of observation, we will evaluate language-specific differences in access and continuity of care as they relate to differences in implementation of the four TLPRs as well as hiring of bilingual providers and provision of language-specific programs. At the same time, we will control for differences in county sociodemographic environments, mental health systems, as well as changes in access and continuity for English-speaking persons. The analysis will, be carried out using Medi-Cal Specialty Mental Health Claims data and Medi-Cal Eligibility data obtained from the California DMH. Other state data sources will be used to measure county and service system characteristics. Primary data will be collected from county cultural competency plans and state compliance review reports documenting each county's implementation of the TLPRs, and the availability of bilingual providers and language-specific programs. Individual in-depth interviews will be conducted by trained bilingual interviewers with limited-English consumers to obtain their perspectives on how the TLPRs, and other county mental health activities, have helped or hindered access to and continuity of mental health care.