Distribution of Child Mental Health Workforce and Health Care for Children with Autism

摘要 满足自闭症儿童的需求已成为一个日益重要的公共卫生问题 和其他自闭症谱系障碍（ASD），其是复杂的发育障碍，其特征在于 重复行为和延迟的社会互动和沟通。研究表明， 在过去的十年中，儿童中自闭症的患病率增加了一倍多。最近的研究也 发现自闭症儿童的心理健康（MH）护理需求大量未得到满足。虽然多种因素 造成未满足的需求，一个重要的促成因素可能是缺乏足够的儿童MH劳动力， 尤其是儿童精神科医生的“严重短缺”。然而，还没有人做过任何工作来了解MH是否 护理更容易获得，患者体验和满意度更好， 儿童MH劳动力的供应量高于供应量较低的地区。 为了填补这一差距，本研究旨在提供及时的经验证据， 卫生部为自闭症儿童提供卫生部护理的劳动力供应。我们的具体目标是： 目标1。审查按学科分列的儿童心理健康劳动力供应与获得 孤独症儿童心理卫生保健的利用、体验和满意度。 目标2.审查按学科分列的儿童MH劳动力供应与家庭负担之间的关系 of children儿童with autism自闭症. 目标3：检查儿童精神卫生工作人员供应对精神卫生保健的影响 获得、满意度和家庭负担因种族和族裔或城乡居住地而异。 建议的计划是创新的，因为（1）与以往的研究不同，我们会研究 多学科同时进行，以及（2）我们的结构，医生进入和市场的计量经济学模型 结构是明确的因果关系，从而提供了一个答案，最常见的反对意见的方法，通常 在以前的研究中使用的医生供应和医疗保健的地理差异之间的关联。 由于多种原因，拟议的研究非常重要。首先，如果没有足够的MH供应， 提供者，目前努力加强NIMH的公共卫生影响， 经过研究检验的干预措施无法取得最佳效果。第二，有专家呼吁， 对儿童MH供应不足和分布不均的挑战性问题进行更多的实证研究 劳动力这项拟议中的研究响应了这一呼吁，它将产生经验证据， 政策制定者在解决这一具有挑战性的问题时必须提供重要信息。据我们所知， 该项目将是第一个评估MH劳动力供应如何影响精神卫生保健的获得，满意度和 自闭症儿童的家庭负担这也将是第一次研究MH劳动力供应是否 改善或加剧这一儿童群体中MH卫生保健的现有差距。

ABSTRACT It has become an increasingly important public health issue to meet the needs of children with autism and other autism-spectrum disorders (ASDs), which are complex developmental disorders characterized by repetitive behavior and delayed social interaction and communication. Studies have indicated that the prevalence of ASDs among children has more than doubled during the past decade. Recent studies have also found substantial unmet mental health (MH) care needs among children with ASDs. While multiple factors contribute to the unmet needs, one important contributing factor is likely an insufficient child MH workforce, especially a “critical shortage” of child psychiatrists. Yet no work has been done to understand whether MH care is more accessible and patient experience and satisfaction are better for children with autism in areas with higher supply of child MH workforce than in those areas with lower supply. To fill the gap, this study is designed to provide timely empirical evidence of the consequences of child MH workforce supply on MH care for children with autism. Our specific aims are: Aim 1. Examine the relationship between the child MH workforce supply, by discipline, and access to, utilization of, and experience and satisfaction with mental health care for children with autism. Aim 2. Examine the relationship between the child MH workforce supply, by discipline, and family burden of children with autism. Aim 3. Examine whether the effects of child mental health workforce supply on mental health care access, satisfaction, and family burden differ by race and ethnicity or between rural and urban residence. The proposed project is innovative because (1) unlike previous studies, we will examine the supply of multiple disciplines simultaneously, and (2) our structural, econometric model of physician entry and market structure is explicitly causal, thus providing an answer to the most common objections to the methods typically used in the previous studies of association between physician supply and geographic variations in health care. The proposed research is highly significant for multiple reasons. First, without an adequate supply of MH providers, the current efforts to strengthen the public health impact of NIMH supported dissemination of research-tested interventions would not be able to achieve optimal effects. Second, some experts have called for more empirical studies of the challenging issue of insufficient and maldistributed supply of child MH workforce. This proposed study responds to the call, and it will generate empirical evidence that will provide policymakers critical information as they address this challenging issue. To our knowledge, the proposed project will be the first to assess how MH workforce supply affects mental health care access, satisfaction and family burden for children with autism. It will also be the first study to examine whether MH workforce supply ameliorates or exacerbates existing disparities in MH health care among this group of children.