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）：成年人在获得精神卫生保健服务和质量方面存在种族/民族差异，这一点有据可查。类似的差异影响着少数群体儿童和青少年。拟议的研究旨在记录少数族裔与白人在精神危机护理方面的差异，并解释它们反映了获得社区服务的差异。它采用横断面、纵向（1998-2001 年）的视角，研究了负责多种族加利福尼亚州医疗补助心理健康服务的 57 个自治县级心理健康项目。具体问题是：根据医院危机稳定和诊所危机干预就诊衡量，非裔美国人、拉丁裔和亚裔美国儿童和青少年是否比白人经历更多与危机相关的护理？社区儿童在危机护理方面的种族差异是否比寄养儿童更明显？也就是说，寄养儿童及其相关的心理健康问题监测和转诊是否会减少危机护理方面的差异？危机护理中的种族差异是否受到联动经纪和门诊护理使用差异的影响？二手数据来自加州心理健康部 Medi-Cal 索赔文件。主要数据是从年度州县合同和合规审查中收集和编码的。数据被组织为嵌入在三年期间每年观察到的县系统中的客户级观察结果。我们建立了危机利用中客户层面种族差异的模型，并通过使用固定效应或通过直接指定纵向和横向变化的县特征来消除任何令人困惑的县层面变化。衡量两种类型的危机护理使用（危机稳定和干预）的因变量在单独的模型中指定为任何使用的概率 (0, 1)，以及如果使用的话，使用水平（就诊次数）。主要自变量是代表客户种族的分类 (0, 1) 变量。种族系数的大小和方向将揭示危机利用中种族差异的程度。我们通过输入寄养分类变量并观察其对种族变量系数的影响来评估危机护理使用、种族和寄养状况之间的关系。同样，我们测试了客户的门诊/联动经纪使用对危机护理使用中种族差异的影响。