Although children in the child welfare system are among the highest child users of mental health services, little is known about the quality of the services they receive. Currently, there exist national standards of mental health care for these children proposed by the Child Welfare League of America (CWLA), the American Academy of Pediatrics (AAP), and the American Association of Child and Adolescent Psychiatry (AACAP). However, there is no information at the child-level on the extent to which children in the child welfare system receive care that is consistent with these national standards. This study by a new investigator takes advantage of the availability of the country's first nationally representative panel study of children coming into contact with child welfare agencies - the National Survey of Child and Adolescent Well-Being (NSCAW) - to examine the extent to which children in the child welfare system actually receive care consistent with national standards. The linkage of NSCAW to an NIMH-funded companion study of county-level policies - the Caring for Children in Child Welfare study - offers the ability to examine the impact of health financing policies on care consistent with these standards. This study will conduct multilevel analysis using these datasets in order to (1) identify the characteristics of Medicaid- enrolled children coming into contact with child welfare agencies nationwide who are at most risk for not receiving care consistent with national standards; (2) identify individual-level deficiencies in Medicaid coverage (primarily discontinuity of Medicaid coverage over time) that affect receipt of care consistent with national standards; and (3) identify county-level Medicaid policies positively associated with receipt of care consistent with national standards.
These specific aims are consistent with the research direction recommendations of the NIMH Program Announcement (PA-07-213): Research on Mental Health Economics, as well as the recent Institute of Medicine report titled Improving the Quality of Health Care for Mental and Substance-Use Conditions calling for the use of competitive insurance mechanisms to leverage high-quality care. Providing stable health insurance to needy populations is a policy priority for public health, and children in the child welfare system are a particularly vulnerable population with high mental health needs. This study examines the effects of Medicaid coverage on access to high-quality mental health services among a national sample of these children. ? ? ?
| Raghavan, Ramesh (2010) Using risk adjustment approaches in child welfare performance measurement: Applications and insights from health and mental health settings. Child Youth Serv Rev 32:103-112 |
| Raghavan, Ramesh; Inoue, Megumi; Ettner, Susan L et al. (2010) A preliminary analysis of the receipt of mental health services consistent with national standards among children in the child welfare system. Am J Public Health 100:742-9 |
| Raghavan, Ramesh; Lama, Gyanesh; Kohl, Patricia et al. (2010) Interstate variations in psychotropic medication use among a national sample of children in the child welfare system. Child Maltreat 15:121-31 |
| Leslie, Laurel K; Raghavan, Ramesh; Zhang, Jinjin et al. (2010) Rates of psychotropic medication use over time among youth in child welfare/child protective services. J Child Adolesc Psychopharmacol 20:135-43 |
