Traumatic brain injury (TBI) is the leading cause of death and disability for children in the U.S. Disability after TBI is higher among children with no or government insurance, poor family functioning and lower levels of parental education. In a preliminary study, we documented disparities in long term disability after TBI for Hispanic children;Hispanic compared to non-Hispanic White (NHW) children experience significantly larger reductions in health related quality of life, participation in activities, and ability to communicate and care for themselves 3 years after injury. It is unclear if use of rehabilitation services and/or cultural and language barriers contributed to the documented differences. We propose a three-phase research plan to compare patterns and determinants of utilization of rehabilitation services and its association with disability outcomes between Hispanic, NHW and non-Hispanic Black (NHB) children. We will also develop and pilot-test the feasibility and acceptability of a culturally tailored intervention to reduce barriers for use of rehabilitation services by Hispanic children with TBI. The long term goal of this K23 award is for the candidate to develop as an independent researcher in the area of patient outcomes in vulnerable populations and pediatric trauma disparities research. The K23 candidate is an Assistant Professor in the Department of Anesthesiology at the University of Washington. The candidate proposes a five-year training plan with the support of faculty mentors who have expertise in injury outcomes research, community based participatory research, qualitative methods, and intervention trials in minority communities. The University of Washington, Seattle Children's Hospital, and Harborview Injury Prevention and Research Center provide excellent institutional support and resources for this award. The research involves three studies. Study 1 will compare use of inpatient and outpatient rehabilitation services between Hispanic, NHB and NHW pediatric patients with TBI, and its association with disability. Study 2 will compare predisposing enabling and need factors for use of outpatient rehabilitation services between the three ethnic groups. Study 3 will develop and pilot-test a culturally tailored intervention to reduce barriers fr use of rehabilitation services by Hispanic children with TBI. These studies will expand our understanding of the potential reasons for disparities in the provision of care for children with TBI. It will clarify the role of Hispanic ethnicity in the receipt of rehabilitation care and highe risk of disability after TBI, independent of socioeconomic and minority status. It will lay the groundwork for a multicenter study to evaluate a culturally tailored intervention to reduce barriers for use of rehabilitation services by Hispanic families, which can also serve as a model for other vulnerable populations.

Public Health Relevance

Significant disparities in long term disability after traumatic brain injury (TBI) exist for Hispanic children. Identifying patterns and determinants for use of rehabilitation services after TBI will reveal risk factors that can allow intervention strategies t be targeted more effectively to Hispanic Children and other vulnerable populations. The long term goal of this research proposal is to improve functional outcomes and prevent disability after TBI in Hispanic children.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Mentored Patient-Oriented Research Career Development Award (K23)
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Pediatrics Subcommittee (CHHD)
Program Officer
Michel, Mary E
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University of Washington
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United States
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Moore, Megan; Jimenez, Nathalia; Graves, Janessa M et al. (2018) Racial Disparities in Outpatient Mental Health Service Use Among Children Hospitalized for Traumatic Brain Injury. J Head Trauma Rehabil 33:177-184
Jimenez, Nathalia; Quistberg, Alex; Vavilala, Monica S et al. (2017) Utilization of Mental Health Services After Mild Pediatric Traumatic Brain Injury. Pediatrics 139:
Fuentes, Molly M; Apkon, Susan; Jimenez, Nathalia et al. (2016) Association Between Facility Type During Pediatric Inpatient Rehabilitation and Functional Outcomes. Arch Phys Med Rehabil 97:1407-1412.e1
Fuentes, Molly M; Jimenez, Nathalia; Apkon, Susan D et al. (2016) Functional outcomes during inpatient rehabilitation for American Indian and Alaska Native children with traumatic brain injury. J Pediatr Rehabil Med 9:133-41
Moore, Megan; Jimenez, Nathalia; Rowhani-Rahbar, Ali et al. (2016) Availability of Outpatient Rehabilitation Services for Children After Traumatic Brain Injury: Differences by Language and Insurance Status. Am J Phys Med Rehabil 95:204-13
Jimenez, Nathalia; Symons, Rebecca G; Wang, Jin et al. (2016) Outpatient Rehabilitation for Medicaid-Insured Children Hospitalized With Traumatic Brain Injury. Pediatrics 137:
Jaffe, Kenneth M; Jimenez, Nathalia (2015) Disparity in rehabilitation: another inconvenient truth. Arch Phys Med Rehabil 96:1371-4
Jimenez, Nathalia; Osorio, Marisa; Ramos, Jessica L et al. (2015) Functional independence after inpatient rehabilitation for traumatic brain injury among minority children and adolescents. Arch Phys Med Rehabil 96:1255-61
Jimenez, Nathalia; Ebel, Beth E; Wang, Jin et al. (2013) Disparities in disability after traumatic brain injury among Hispanic children and adolescents. Pediatrics 131:e1850-6