Assessing the impacts of Medicaid Home and Community Based Waivers for children with Severe Emotional Disturbance

评估医疗补助家庭和社区豁免对患有严重情绪障碍的儿童的影响

基本信息

批准号：
10429717
负责人：
Genevieve Graaf
金额：
$ 16.68万
依托单位：
UNIVERSITY OF TEXAS ARLINGTON
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-05-01 至 2026-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10429717
关键词：
Accounting Achievement Address Administrator Americans with Disabilities Act Caring Characteristics Child Child Care Clinical Communities Community Services Complex Data Data Analyses Data Collection Data Reporting Data Set Decision Making Diagnosis Disease Distress Effectiveness Enrollment Environment Exhibits Expenditure Family Financial Hardship Funding Goals Grant Health Health Policy Health financing Healthcare Home Home Ranges Improve Access Income Individual Inpatients Instruction Intervention Knowledge Laws Long-Term Care Medicaid Medicaid services Mentors Mentorship Methodology Modeling National Institute of Mental Health Outcome Parents Participant Policies Provider Psychiatric therapeutic procedure Public Health Research Research Design Research Methodology Research Personnel Residential Treatment Resources Risk Risk Factors Services Severities Source Statistical Methods Strategic Planning Structure Symptoms System Techniques Texas Time Time Study Training United States Variant Writing Youth alternative treatment base behavior measurement behavioral health community based service cost data management experience health care service utilization health service use improved improved functioning non-compliance novel patient home care prevent programs residential care facility serious emotional disturbance service intervention service utilization skills statistics symposium training opportunity waiver

项目摘要

PROJECT SUMMARY The overall goal of this K01 application is to estimate the impact of 1915(c) Home and Community-Based Services (HCBS) Medicaid waiver programs for children with Severe Emotional Disturbance (SED) on behavioral health care service use and expenditures for children with SED. Children with severe SED are at significant risk for psychiatric long-term care (LTC) use due to the severity of their symptoms and inability to access alternative community-based behavioral health care. To reduce public financial burdens and family distress associated with use of psychiatric LTC, one in five states offer 1915(c) HCBS Medicaid waiver policies. These policies expand the Medicaid-funded community-based service array for children who exhibit a clinical need for institutional psychiatric care, regardless of family income levels. Though these policies are intended to prevent psychiatric LTC use by providing alternative community-supports, achievement of these goals is unclear. Scant existing research lacks either causal inference or generalizability, as they are cross sectional, regional, or minimally control for clinical variation in program participants. The goal of this K01 is to train the recipient in the statistical and methodological skills needed to study the impacts of health policy on service utilization and expenditure outcomes for children and youth with complex behavioral health needs. Research aims are to 1) create a comprehensive SED waiver policy dataset that codifies the structures and provisions of these policies across states and over time, 2) identify and compare characteristics of children enrolled in SED waiver programs and children who use psychiatric LTC among Medicaid-enrolled children with behavioral health disorders; 2b) assess SED waiver policies and waiver program enrollment’s association with amelioration of adverse risk factors for LTC, and 3) estimate the effects of the Texas SED Waiver and its characteristics on Medicaid-reimbursed behavioral health service use and expenditures. The training aims of the project are to 1) acquire knowledge, skill, and experience in public health law research methods, 2) build knowledge on the assumptions and applicability of research designs and statistical methods for estimating causal effects of behavioral health policy interventions using observational and administrative data, 3) apply current and best practices for defining and measuring behavioral health service use and expenditures using diverse sources of health claims data and 4) obtain the research, writing, and administrative expertise to submit a successful R01 grant during the final year of the K01. Training aims will be accomplished through formal coursework, individualized instruction, seminar and workgroup participation, mentored research, and conference participation. Research aims will use data from state SED waiver applications merged with Medicaid claims data from state and federal resources. This project will provide novel evidence for policymakers nationwide regarding which children may be at risk for psychiatric institutional care, the policy or service interventions that may reduce these risks, and what costs may be associated with these interventions.

项目概要此 K01 应用程序的总体目标是评估 1915(c) 家庭和社区的影响服务 (HCBS) 针对患有严重情绪障碍 (SED) 的儿童的医疗补助豁免计划患有 SED 的儿童的行为保健服务的使用和支出为：由于症状严重且无法接受精神科长期护理 (LTC)，因此存在重大风险获得基于社区的替代行为医疗保健减轻公共财政负担和家庭负担。与使用精神科 LTC 相关的痛苦，五分之一的州提供 1915(c) HCBS 医疗补助豁免这些政策扩大了医疗补助资助的针对表现出残疾的儿童的社区服务范围。无论家庭收入水平如何，都需要机构精神科护理，尽管这些政策是。旨在通过提供替代社区支持来防止精神科长期护理治疗的使用，实现这些目标现有的研究很少缺乏因果推理或普遍性，因为它们是交叉的。对项目参与者的临床变异进行分区、区域或最低程度的控制该 K01 的目标是：对接受者进行研究卫生政策影响所需的统计和方法技能方面的培训具有复杂行为健康需求的儿童和青少年的服务利用和支出结果。研究目标是 1) 创建一个全面的 SED 豁免政策数据集，将结构和随着时间的推移，各州对这些政策的规定，2) 识别和比较儿童的特征参加 SED 豁免计划的儿童以及在参加 Medicaid 的患有以下疾病的儿童中使用精神科 LTC 的儿童行为健康障碍；2b) 评估 SED 豁免政策和豁免计划注册与改善长期护理 (LTC) 的不利风险因素，以及 3) 估计德克萨斯州 SED 豁免及其影响医疗补助报销的行为健康服务使用和支出的特点培训目标。该项目旨在 1) 获取公共卫生法研究方法方面的知识、技能和经验，2) 建立有关研究设计的假设和适用性以及估计统计方法的知识使用观察和管理数据的行为健康政策干预的因果效应，3) 适用定义和衡量行为健康服务使用和支出的当前和最佳实践健康声明数据的不同来源，4) 获得研究、写作和管理专业知识，以在 K01 的最后一年提交成功的 R01 补助金培训目标将通过以下方式实现。正式课程、个性化指导、研讨会和工作组参与、指导研究以及会议参与的研究目标将使用来自州 SED 豁免申请的数据。该项目将为医疗补助索赔数据提供新的证据。全国决策者关于哪些儿童可能面临接受精神病机构护理的风险、政策或可以降低这些风险的服务干预措施，以及这些干预措施可能产生的成本。