The proposed research consists of three aims.
The first aim will examine how families finance child mental health, focusing on the effects of child mental health on parental labor market participation, and using an economic model of family production. In such models, families do not desire mental health services per se--they desire healthy children. Health (physical, behavioral, and emotional) is produced in children using a combination of health services and time spent caring for the child. Families finance child mental health by allocating their time between working for pay and time spent caring for and transporting children, and by combining purchased health care services with household time. Health insurance, public and private, will be incorporated into the model of household production and estimates of the labor market effects of insurance (public and private) will be estimated. This study will generate estimates of the source and magnitude of foregone wages (and leisure) associated with child mental illness. The economic opportunities and incentives faced by single parent and two parent households differ substantially. As -part of the analysis of the first aim, this study will treat family structure as an endogenous variable and focus on how child health can affect family structure. An empirical model will be used to determine whether families of mentally ill children are at increased risk of discord within marriage, separation, and divorce. Mental health services are not consumed uniformly over geographic areas by those with similar income and need. Local and regional average income levels, subjective views of service effectiveness and stigma, and the quality and availability of particular services will all likely affect area rates of service use.
The second aim will estimate the effects of these regional factors on the use of child mental health services, using detailed measures to control for service need and other individual effects. Assessing the importance of area effects depends on adjusting for the possibility that families needing services migrate to where they are more available. This study will also measure the effect of service need on such family migration. Two data sets will be used for this study: NIMH's 1992 Methodological Epidemiology of Children and Adolescents (MECA) field trial of 1285 community children and adolescents from 4 regions of the United States, which contains family demographic and socioeconomic information and detailed descriptions of children's use of mental health services, multiple measures of mental health, and measures of perceived barriers to service use; and the NLSY Child File, which contains information on an expanding sample (around 6500) of children born to mothers that the NLSY has been following since 1979. The NLSY contains detailed information about the mother's labor supply, family demographic and socioeconomic information. The data are linked to the Child File, which consists of information from a battery of child cognitive-socioemotional-physiological assessments administered to NLSY mothers and their children during the 1986, 1988, 1990, and 1992 NLSY surveys. To give my empirical research a human context, I will also attend meetings of a support group for families of children with mental health problems.
