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.
| Snowden, Lonnie R; Masland, Mary C; Libby, Anne M et al. (2008) Racial/ethnic minority children's use of psychiatric emergency care in California's Public Mental Health System. Am J Public Health 98:118-24 |
