Ethnic Minority Children in Public Mental Health

公共心理健康中的少数民族儿童

• 批准号: 7065650
• 负责人: LONNIE Roscoe SNOWDEN
• 金额: $ 26.45万
• 依托单位: UNIVERSITY OF CALIFORNIA BERKELEY
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-08-04 至 2008-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7065650
• 关键词: African American; Asian Americans; Hispanic Americans; adolescence (12-20); behavioral /social science research tag; caucasian American; child (0-11); child foster care /adoption; child mental health service; child welfare; clinical research; emergency care; health care service availability; health disparity; health services research tag; human data; mathematical model; psychiatric patient care; racial /ethnic difference

DESCRIPTION (provided by applicant): Racial/ethnic disparities in access and quality of mental health care are well documented among adults. Parallel differences affect minority children and youth. The proposed study seeks to document minority-white disparities in psychiatric crisis care and to explain them as reflecting differential access to community-based services. It takes a cross-sectional, longitudinal (1998-2001) perspective of the 57 autonomous county-level mental health programs responsible for Medicaid mental health services in the ethnically diverse state of California. Specific questions are: Do African American, Latino, and Asian American children and youth experience more crisis-related care than whites as measured by hospital-based crisis stabilization and clinic-based crisis intervention visits? Are ethnic disparities in crisis care more pronounced for children in the community than for those in foster care, i.e. does placement in foster care, with its associated monitoring and referral for mental health problems, decrease disparities in crisis care? Are ethnic disparities in crisis care affected by differences in use of linkage-brokerage and outpatient care? Secondary data come from California Department of Mental Health Medi-Cal claims files. Primary data are collected and coded from annual state-county contracts and compliance reviews. Data are organized as client-level observations embedded within county systems observed annually over the 3-year period. We build models of client-level ethnic disparities in crisis use and remove any confounding county-level variation through the use of fixed effects, or through direct specification of county characteristics when they vary both longitudinally and cross-sectionally. Dependent variables, measuring the two types of crisis care use -- crisis stabilization and intervention -- are specified in separate models as the probability of any use (0, 1), and if used, the level of use (# of visits). Main independent variables are categorical (0, 1) variables representing the client's ethnicity. The magnitude and direction of the ethnicity coefficients will reveal the level of ethnic disparities in crisis use. We assess relationships between crisis care use, ethnicity and foster care status by entering foster care categorical variables and observing their effect on the ethnic variables' coefficients. Similarly, we test the effect of clients' outpatient/linkage-brokerage use on ethnic disparities in crisis care use.

描述（由申请人提供）：成年人在访问和精神卫生保健方面的种族/种族差异已得到充分记录。平行差异会影响少数儿童和青少年。拟议的研究旨在记录精神病危机护理中的少数群体白人差异，并将其解释为反映了对基于社区的服务的差异访问。它采用了横断面的纵向（1998-2001），对负责加利福尼亚州各种各样的医疗补助精神卫生服务的57个自治县级心理健康计划的观点。具体问题是：非洲裔美国人，拉丁裔和亚裔美国儿童和青少年是否比以医院危机稳定和基于诊所的危机干预访问来衡量的白人相比，与白人相比，危机相关的护理更多？危机护理中的种族差异对社区的儿童而言是否比寄养者更明显，即寄养护理中的安置，以及其相关的监测和针对心理健康问题的转诊，减少危机护理中的差异吗？危机护理中的种族差异是否会受到连锁经纪和门诊护理差异的影响？次要数据来自加利福尼亚心理健康部Medi-Cal索赔文件。主要数据是根据年度县年合同和合规性审查收集和编码的。将数据组织为在三年期间每年观察到的县系统中嵌入的客户级观察结果。我们在危机使用中建立了客户级族裔差异的模型，并通过使用固定效应来消除任何混淆的县级变化，或者通过纵向和横截面变化时县特征的直接规范。在单独的模型中指定了因变量，测量两种类型的危机护理使用 - 危机稳定和干预 - 是任何用途的概率（0，1），如果使用，则使用级别（访问＃）。主要独立变量是代表客户种族的分类变量（0，1）。种族系数的规模和方向将揭示危机使用中种族差异的水平。我们通过进入寄养者的分类变量并观察它们对种族变量系数的影响，评估危机护理使用，种族和寄养状况之间的关系。同样，我们测试了客户门诊/连锁经纪使用对危机护理中种族差异的影响。