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This study considers residential segregation as a critical driver of racial/ethnic health disparities and introduces a proxy measure of segregation that estimates the degree of segregation at the census tract level with a metric capturing the overrepresentation of a racialized/ethnic group in a census tract in relation to that group's representation at the city level. Using Dallas, Texas as a pilot city, the measure is used to investigate mean life expectancy at birth for relatively overrepresented Hispanic, non-Hispanic white, non-Hispanic Black, and Asian census tracts and examine for significant differences between mean life expectancy in relatively overrepresented census tracts and that group's mean life expectancy at the state level. Multivariable linear regression analysis was utilized to assess how segregation measured at the census tract level associates with life expectancy across different racialized/ethnic groups, controlling for socioeconomic disparities. This study aimed to expose the need to consider the possibility of neighborhood mechanisms beyond socioeconomic characteristics as an important determinant of health and draw attention to the importance of critically engaging the experience of place in examinations of racial and ethnic health disparities. Multivariable linear regression modeling resulted in significant findings for non-Hispanic Black, non-Hispanic white, and Asian groups, indicating increased census tract-level life expectancy for Black and white residents in highly segregated census tracts and decreased life expectancy for residents of tracts in which the Asian community is overrepresented when compared to state means. Unadjusted models demonstrated socioeconomic inequities between first and fourth quartile census tracts and pointed to the importance of mixed methods in health disparities research and the importance of including the voice of community members to account for places of daily lived experience and people's relationships with them.
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Censos , Esperanza de Vida , Femenino , Humanos , Masculino , Etnicidad/estadística & datos numéricos , Disparidades en el Estado de Salud , Características del Vecindario , Proyectos Piloto , Grupos Raciales/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Segregación Social , Factores Socioeconómicos , Texas , Blanco , Negro o Afroamericano , Hispánicos o Latinos , AsiáticoRESUMEN
Although studies have investigated and found an association between adverse childhood experiences and poor health and mental health outcomes, there is a dearth of studies investigating the association between adverse childhood experiences and unmet health care needs among children. The objective of this study is to examine the association between adverse childhood experiences and unmet health care needs after adjusting for predisposing, enabling, and need factors of health care service utilization. Data for this study came from the 2016-2017 National Survey of Children's Health. An analytic sample of 46,081 children (51.3% males; average age 11.5 years) was analyzed using negative binomial regression. Based on parent reports, about 3.5% of children had unmet health care needs, and half (50%) of the sample had experienced at least one childhood adversity. Controlling for other factors, children who experienced three or more childhood adversities had 4.51 times higher odds of having unmet health care needs (AOR = 4.51, p < .001, 95% CI = 3.15-6.45) when compared to their counterparts with no childhood adversity. Children with parents who have someone to turn to for everyday emotional support were 31% less likely to have unmet health care needs (AOR = .69, p < .01, 95% CI = .54-.89). Adverse childhood experiences have a detrimental effect on unmet health care needs. The findings of this study offer an important opportunity for further research on how best to prevent adverse childhood experiences and mitigate their impact on families.
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Experiencias Adversas de la Infancia , Niño , Masculino , Humanos , Estados Unidos , Femenino , Accesibilidad a los Servicios de Salud , Necesidades y Demandas de Servicios de Salud , Evaluación de NecesidadesRESUMEN
This project documents the service outcomes that caregivers value most. A diverse group of caregivers, representing six regions of the United States, participated in two rounds of virtual one-hour focus groups. In round 1, participants identified what they hoped to gain from using behavioral health services for themselves, their families, and their child and discussed what made services a positive experience for them. They then reported their top-three most-hoped-for outcomes. In round 2, groups validated and refined summary findings from round 1. Caregivers prioritized service quality outcomes, primarily. They expressed a desire for an accessible, respectful, and supportive treatment environment, underpinned by well-trained and culturally responsive professionals. Caregivers also desire seamless cross-sector provider collaboration and care transitions, which integrate the insights and preferences of families and children themselves to craft a customized care plan. Priority outcomes not related to service quality included hoping to gain increased knowledge, resources, and tools and techniques to support the mental health needs of their children, to see their children improve their daily functioning and for their child develop more effective interpersonal communication skills. Caregivers also reported hoping to experience less stigma related to the mental health needs of their children and to achieve personal fulfillment for themselves and their children. Research, policies, and mental health services should prioritize and be designed to address the outcomes that matter to youth and families.
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Servicios de Salud Mental , Salud Mental , Niño , Humanos , Adolescente , Adulto Joven , Cuidadores/psicología , Grupos Focales , ComunicaciónRESUMEN
To examine the association between psychologist and nurse practitioner scope-of-practice (SoP) regulations and pediatric mental health service access. A nationally representative sample of children with mental health needs was identified using 5 years of National Survey of Children's Health (2016-2020). Utilization was measured in two ways: (1) unmet mental health care needs and (2) receipt of mental health medication. Expanded SoP for psychologists and nurse practitioners was measured based on the child's state of residence and the year of the survey. The associations between both SoP expansion and both outcomes were assessed using logistic regression models adjusted for multiple covariates. The probability of having unmet mental health needs was 5.4 percentage points lower (95% CI - 0.102, - 0.006) for children living in a state with psychologist SoP expansion; however, there was no significant difference in unmet mental health needs between states with and without NP SoP expansion. The probability of receiving a mental health medication was 2.0 percentage points higher (95% CI 0.007, 0.034) for children living in a state with psychologist SoP expansion. Conversely, the probability of receiving a mental health medication was 1.5 percentage points lower (95% CI - 0.023, - 0.007) for children living in a state with NP SoP expansion. Expanded SoP for psychologists is associated with improved access to pediatric mental health care in terms of both unmet need and receiving medication. Expanded SoP for NPs, however, was not associated with unmet need and lower receipt of medication.
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Accesibilidad a los Servicios de Salud , Servicios de Salud Mental , Enfermeras Practicantes , Alcance de la Práctica , Humanos , Servicios de Salud Mental/organización & administración , Niño , Masculino , Femenino , Adolescente , Accesibilidad a los Servicios de Salud/organización & administración , Estados Unidos , Preescolar , Servicios de Salud del Niño/organización & administración , Trastornos Mentales/terapia , Necesidades y Demandas de Servicios de Salud , PsicologíaRESUMEN
Eleven states offer 1915(c) Home and Community Based Services (HCBS) Medicaid waivers to organize and fund programs that provide in-home and community support services to address the unique needs of children and youth with complex mental health concerns and their families. However, as the COVID-19 pandemic-imposed restrictions on community movement and school engagement were enacted, these children and youth lost in-person access to needed supports through school-based programs and professional community providers. The well documented mental health impacts of the pandemic on children and youth necessitates understanding how behavioral health programs and policies were adapted to the constraints of pandemic life for this uniquely at-risk population. This study examines and characterizes trends in modifications made to these programs. Appendix K applications amending HCBS waiver programs targeting children with serious emotional disturbances (SED) were collected from the Center for Medicaid & Medicare Services (CMS) website. In total, 33 applications from 10 states were included in the study. Utilizing a policy mapping approach, applications were coded by hand comparing text from elements in the applications across all 10 states. A summary of program changes reported in applications was created and changes were tracked over the course of the federal public health emergency. States modified programs by adding services for waiver participants, changing the service settings allowed, removing service limit restrictions, and offering electronic/remote service delivery. All states also issued measures to either expand or retain their provider workforce, adding family members as providers, modifying experience requirements, and offering financial incentives via increased payment rates or retainer payments. Modifications to mental health assessment processes ranged from changing the evaluation tools or documentation requirements, extending deadlines, and allowing for remote evaluations. Service plan development processes were adapted by allowing virtual service plan development meetings, allowing participants or representatives to electronically sign plans of care, and permitting verbal consent to begin receiving services. Documenting programmatic adjustments provides a context for further research to understand the experiences of youth, families, and providers in navigating these changes and the relative success or failures of these policies.
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COVID-19 , Servicios de Atención de Salud a Domicilio , Anciano , Niño , Adolescente , Humanos , Estados Unidos , Salud Mental , Servicios de Salud Comunitaria , Pandemias , Medicare , MedicaidRESUMEN
OBJECTIVE: Caregivers of children with special health care needs (CSHCN) experience substantial strain caring for their child's special needs because of high needs for health and other support services. Caregivers of CSHCN with emotional, behavioral, or developmental problems (EBDPs) report stress and poor mental health at higher rates than caregivers of other CSHCN. Although family support services are associated with caregiver mental health and well-being among families of CSHCN, the association of these factors with caregiver coping has been underexamined. METHOD: Using the Double ABCX Model of Family Adaptation to guide variable selection, this study uses 2016 to 2019 data from the National Survey of Children's Health. Univariate, bivariate, and multivariate logistic analyses examined the association between caregivers' receipt of adequate care coordination and emotional support services and their reported coping with the day-to-day strains of parenting. These relationships are compared between caregivers of CSHCN with and without EBDPs. RESULTS: Receipt of adequate care coordination was associated with higher rates of caregiver-reported positive coping for all caregivers of CSHCN who have no source of emotional support. Receipt of emotional support services was associated with increased reports of positive coping for caregivers for all CSHCN as well. Caregivers reporting only informal sources of emotional support, however, also reported higher rates of positive coping when compared with caregivers with no source of emotional support. CONCLUSION: Mobilization of resources that can aid caregivers in coordinating care and provide emotional support may play a key role in positive caregiver coping for families of CSHCN.
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Niños con Discapacidad , Niño , Humanos , Cuidadores , Apoyo Familiar , Discapacidades del Desarrollo , Habilidades de Afrontamiento , Padres , Necesidades y Demandas de Servicios de SaludRESUMEN
BACKGROUND: In the United States, the Affordable Care Act (ACA) pursued equity in healthcare access and treatment, but ACA implementation varied, especially limiting African Americans' gains. Marketplaces for subsidized purchase of coverage were sometimes implemented with limited outreach and enrollment assistance efforts. Reflecting state's ACA receptivity or reluctance, state's implementation may rest on sociopolitical stances and racial sentiments. Some states were unwilling to provide publicly supported healthcare to nonelderly, non-disabled adults- "the undeserving poor" -who evoke anti-black stereotypes. The present study assessed whether some states shunned Affordable Care Act (ACA) marketplaces and implemented them less vigorously than other states, leading to fewer eligible persons selecting insurance plans. It assessed if states' actions were motivated by racial resentment, because states connote marketplaces to be government assistance for unworthy African Americans. METHODS: Using marketplace and plan selection data from 2015, we rated states' marketplace structures along a four-level continuum indicating greater acceptance of marketplaces, ranging from states assuming sole responsibility to minimal responsibility. Using national data from a four-question modern racism scale, state-wide racial resentment estimates were estimated at the state level. Analysis assessed associations between state levels of racial resentment with states' marketplace structure. Further analysis assessed relationships between both state levels of racial resentment and states' marketplace structure with states' consumer plan selection rates-representing the proportion of persons eligible to enroll in insurance plans who selected a plan. RESULTS: Racial resentment was greater in states with less responsibility for the administration of the marketplaces than actively participating states. States higher in racial resentment also showed lower rates of plan selection, pointing to less commitment to implementing marketplace provisions and fulfilling the ACA's coverage-improvement mission. Differences persisted after controlling for differences in conservatism, uninsurance, poor health, and rejection of Medicaid expansion. CONCLUSIONS: Resentment of African Americans' purported irresponsibility and entitlement to government assistance may interfere with states structuring and operating marketplaces to maximize health insurance opportunities for everyone available under the ACA. TRIAL REGISTRATION: N/A.
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Intercambios de Seguro Médico , Patient Protection and Affordable Care Act , Adulto , Humanos , Estados Unidos , Estudios Transversales , Cobertura del Seguro , Seguro de Salud , MedicaidRESUMEN
Objective: There are well-documented disparities in access to mental health care for children and youth with significant behavioral health needs. Few studies that explored the differential experiences of families who use private vs public sources of financing (i.e., insurance and funding) in accessing residential treatment (RT) for children and youth. This study aimed to examine the lived experiences of families accessing psychiatric residential treatment (RT) and contextualize these experiences based on source of financing. Methods: Twenty parents completed two interviews about their experiences with RT including the process for gaining access, length of stay, and aftercare. Parents were also asked about barriers (e.g., custody relinquishment), and facilitators (e.g., policies in the state) to accessing RT. Data were analyzed using content analysis. Results: There were three distinct groups of families in the study. The first group includes lower income families whose children had public health coverage before needing RT. The second group comprises middle-income families whose children had private coverage but lived in states where there were no RTs that accepted private insurance or private payment and who did not have the means to send their child to RT in another state. The final group included higher income families with private insurance and enough private resources to overcome the limitations of insurance and state policies. This study illuminates key barriers and hardships for families accessing RT: 1) waiting long waiting periods and navigating complex systems; 2) inadequate lengths of stay; and 3) inadequate aftercare and support in the community transition. Conclusions: This study is among the first to examine how access to RT differs by whether a family has access to public or private resources. Taken together, these findings support the importance of insurance and financing for families accessing RT for their children and the need for systemic changes in policies and practices to reduce disparities in access.
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PURPOSE: The purpose of this scoping review was to document the state of the literature regarding the challenges experienced by rural informal caregivers of older adults in the United States. METHOD: We reviewed peer-reviewed academic articles published through December 1, 2021, based on Arksey and O'Malley's framework. RESULTS: The initial search resulted in 1,255 articles, of which 12 studies were included for the final review. Thematic content analysis was utilized to identify emerging themes of challenges experienced by rural informal caregivers of older adults. The identified challenges include a lack of knowledge regarding resources, financial difficulties, health-related challenges, and barriers related to geographic distance. DISCUSSION AND CONCLUSION: The implications of these challenges are used to shape recommendations for social work, service planning, and policy changes that can improve caregiving experiences for rural families.
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Cuidadores , Servicio Social , Humanos , Estados Unidos , Anciano , Población Rural , PolíticasRESUMEN
The Affordable Care Act's Marketplaces, by allowing subsidized purchase of insurance coverage by persons with incomes from the poverty line to middle income, and through active outreach and enrollment assistance efforts, are well situated to reduce large African American-white private coverage disparities. Using data from the National Health Interview Survey for multiyear periods before and after Affordable Care Act implementation, from 2011-2013 to 2015-2018, this study assessed how much disparity reduction occurred when Marketplaces were implemented. Analysis compared private coverage take-up by African Americans and whites for persons with incomes between 100 and 400% of the Federal Poverty Line (FPL), controlling for African American-white income differences and other covariates. African Americans' gains were significantly greater than whites' and disparities did close. However, both groups gained considerably less coverage than they might have, and some disparity remained. To make ongoing operations more effective and to guide future subsidy extensions and increases as enacted in the American Rescue Plan, more research is needed into the incentive value of subsidies and to discover which Marketplace outreach and enrollment assistance efforts were most effective. In advancing these aims, high priority should be given to identifying strategies that were particularly successful in reaching and engaging uninsured African Americans.
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Medicaid , Patient Protection and Affordable Care Act , Humanos , Estados Unidos , Pacientes no Asegurados , Pobreza , Renta , Seguro de SaludRESUMEN
INTRODUCTION: Children and youth with special health care needs (CYSHCN) are vulnerable to health care disruption, and policies were adopted to mitigate COVID-19-related disruptions. We compare CYSHCN use of and access to care in 2019 to 2020. METHOD: Using the National Survey of Children's Health, we identified CYSHCN and assessed differences in health care use, unmet health care needs, frustrations accessing care, and barriers to care using multivariable logistic regression analysis. RESULTS: The final sample included 17,065 CYSHCN. In the fully adjusted analysis, there was a significant decrease in odds of accessing preventive dental care (adjusted odds ratio [AOR], 0.63; 95%confidence interval [CI], 0.51-0.77) and increased odds of unmet mental health care needs (AOR,1.34; 95% CI, 1.02-1.77). The inability to obtain an appointment was a barrier that increased during the study period (AOR, 2.77; 95% CI, 1.71-4.46). DISCUSSION: Novel pandemic related policies may have mitigated negative impacts on health care access for CYSHCN.
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COVID-19 , Servicios de Salud del Niño , Niños con Discapacidad , Niño , Humanos , Adolescente , Pandemias , Necesidades y Demandas de Servicios de Salud , Accesibilidad a los Servicios de SaludRESUMEN
OBJECTIVE: Parents of children with special health care needs (CSHCN) report that private insurance is less adequate than public health coverage. Parents of CSHCN with emotional, behavioral, or developmental problems (EBDPs) may perceive private insurance to be especially inadequate due to higher need for a wider array of non-medical services and supports. This study's objective is to assess differences in parent ratings of insurance adequacy for public versus private health coverage between non-CSHCN, CSHCN, and CSHCN with EBDPs. METHODS: This study pooled publicly available data from the 2016 through 2019 National Survey of Children's Health. Multivariable fixed effects logistic regression models estimated the association between insurance type, CSCHN and EBDP status, and parent ratings of their child's insurance adequacy. Marginal effects were calculated for insurance type, CSHCN and EBDP status, and their interactions to estimate the size of the association. RESULTS: Among all subgroups, consistently more parents with publicly insured children rated their insurance as adequate compared to those with private insurance. Parents of privately insured CSHCN with EBDPs rated their insurance as adequate at significantly lower rates than any other group of parents (55%)-including those with privately insured children without EBDPs (non-CSHCN= 67%; CSHCN = 63%) and all other parents with publicly insured children (non-CSHCN = 87%; CSHCN = 83%; CSHCN with EBDPs = 84%). CONCLUSIONS: Future research should investigate if perceptions of insurance adequacy among families whose CSHCN has an EBDP aligns with reports of service access and unmet health care needs.
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Niños con Discapacidad , Niño , Humanos , Estados Unidos , Necesidades y Demandas de Servicios de Salud , Cobertura del Seguro , Seguro de Salud , Padres , Accesibilidad a los Servicios de SaludRESUMEN
OBJECTIVE: To report rates of need and unmet need for specialised health services (occupational and speech therapies, durable medical equipment, home healthcare, and mobility and communication aids) from the National Survey of Children with Special Health Care Needs (CSHCN) (2009/2010) and assess the role of care coordination in having needs met. We distinguish between CSHCN with and without emotional, behavioural and developmental disorders (EBDPs) in the USA. DESIGN: A cross sectional cohort study of a nationally representative sample of CSHCN from the National Survey of CSHCN for 2009/2010 used logistic regression to assess the relationship between EBDPs and need and unmet need for specialised services. It also estimates the association of care coordination with unmet need for all services, for CSHCN with and without EBDPs. SETTING: A nationally representative sample of CSHCN in the USA. PARTICIPANTS: Children ages 0-17 years of age. RESULTS: Across all specialised health services, rates of unmet need were at or below 25%. Need and unmet need for most services was higher among CSHCN with EBDPs than those without. For CSHCN with and without EBDPs, adequate care coordination was associated with greater probability of having needs for therapy, home health and communication aids met. CONCLUSION: Care coordination is essential to reducing barriers to a wide range of healthcare services for CSCHN. Policies requiring adequate insurance coverage for care coordination may play a critical role in ensuring access to specialised health services.
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Servicios de Salud del Niño , Niños con Discapacidad , Adolescente , Niño , Preescolar , Humanos , Lactante , Recién Nacido , Estudios Transversales , Atención a la Salud , Necesidades y Demandas de Servicios de Salud , Estados UnidosRESUMEN
OBJECTIVES: To investigate the impact of the Affordable Care Act's (ACA) Medicaid expansion on African American-white disparities in health coverage, access to healthcare, receipt of treatment, and health outcomes. DESIGN: A search of research reports, following the PRISMA-ScR guidelines, identified twenty-six national studies investigating changes in health care disparities between African American and white non-disabled, non-elderly adults before and after ACA Medicaid expansion, comparing states that did and did not expand Medicaid. Analysis examined research design and findings. RESULTS: Whether Medicaid eligibility expansion reduced African American-white health coverage disparities remains an open question: Absolute disparities in coverage appear to have declined in expansion states, although exceptions have been reported. African American disparities in health access, treatment, or health outcomes showed little evidence of change for the general population. CONCLUSIONS: Future research addressing key weaknesses in existing research may help to uncover sources of continuing disparities and clarify the impact of future Medicaid expansion on African American health care disparities.
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Disparidades en Atención de Salud , Medicaid , Adulto , Negro o Afroamericano , Accesibilidad a los Servicios de Salud , Humanos , Cobertura del Seguro , Persona de Mediana Edad , Patient Protection and Affordable Care Act , Estados UnidosRESUMEN
Places-the meaningful locations of daily life-have been central to the wellbeing of humans since they first formed social groups, providing a stable base for individuals, families, and communities. In the United States and Canada, as elsewhere, place also plays a foundational role in the provision of critical social and health services and resources. Yet the globally destabilizing events of the COVID-19 pandemic have dramatically challenged the concept, experience, and meaning of place. Place-centered public health measures such as lockdowns and stay-at-home orders have disrupted and transformed homes, neighborhoods, workplaces, and schools. These measures stressed families and communities, particularly among marginalized groups, and made the delivery of vital resources and services more difficult. At the same time, the pandemic has stimulated a range of creative and resilient responses. Building from an overview of these effects and drawing conceptually on theories of people-place relationships, this paper argues for critical attention to reconsidering and re-envisioning prevailing assumptions about place-centric policies, services, and practices. Such reappraisal is vital to ensuring that, going forward, scholars, policymakers, and practitioners can effectively design and deliver services capable of maintaining social connections, safety, and wellbeing in contexts of uncertainty, inequality, and flux.
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Caregivers of children with special health care needs (CSHCNs), especially those whose children have emotional, behavioral, or developmental problems (EBDPs), experience considerable strain and stress related to caring for their child's special needs. The enormous burden of caregiving can decrease a parent's ability to provide care, impacting the health of the child, the parents, and overall family functioning. To manage these challenges, these parents report the need for mental health care for themselves or their children, but many families with need go without care. Comprehensive knowledge about barriers to family mental health care for families of CSHCN is lacking. This study examines data from the National Survey of Children with Special Health Care Needs (2005/2006 and 2009/2010) to estimate time-specific, population-based prevalence of fourteen specific barriers to family mental health services and identifies risk factors for experiencing barriers to care for families of CSHCN. Among all CSHCN, cost barriers (33.5%) and lack of insurance (15.9%) were the most commonly reported obstacles to service access in 2005 and 2009, followed by inconvenient service times (12.3%), and locations (8.7%). Reports of these barriers increased significantly from 2005 to 2009. All types of barriers to family mental health services were reported significantly more frequently by CSHCN with EBDPs than by those without. CSHCN's race, insurance, and parent education and income levels were factors associated with cost barriers to family mental health care. Understanding barriers to mental health care for families of CSHCN is critical to creating policy and practice solutions that increase access to mental health care for these families.
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OBJECTIVE: The objective of this study was to estimate time-specific, population-based prevalence of 14 specific barriers to respite services, as reported by parents of children with special health care needs (CSHCN) with and without emotional, behavioral, or developmental problems (EBDPs), and to identify individual, family, and environmental characteristics associated with the most common barriers to respite care for families of CSHCN. METHODS: Descriptive, bivariate, and multivariable logistic regression analyses were used to examine data from the National Survey of Children with Special Health Care Needs for 2005/2006 and 2009/2010. RESULTS: Among families reporting unmet need for respite care services, service availability or transportation barriers (23.8%) and cost barriers (19.8%) were the most commonly reported obstacles among all CSHCN, followed by lack of knowledge about where to obtain respite services (12.1%) and inconvenient service times (11.3%). Reports of location or availability barriers decreased significantly from 2005 to 2009, but service time barriers increased simultaneously. All types of barriers to respite services were reported significantly more frequently by CSHCN with EBDPs than those without, even when other demographic factors were controlled for. CSHCN conditional severity and discontinuity in insurance were positively associated with cost barriers, whereas CSHCN public health coverage was associated with reduced rates of reported cost and information barriers to respite care. CONCLUSION: Increased understanding of parent-reported barriers to respite care for families of CSHCN is critical to creating structural and practice-oriented solutions that address obstacles and increase access to respite care for these vulnerable families.
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Niños con Discapacidad , Cuidados Intermitentes , Niño , Atención a la Salud , Encuestas de Atención de la Salud , Accesibilidad a los Servicios de Salud , Necesidades y Demandas de Servicios de Salud , Humanos , Padres , Estados UnidosRESUMEN
OBJECTIVES: This study describes rates of perceived and unmet need for family support services (care coordination, respite care, and family mental health care) among a national sample of children with special health care needs (CSHCN), distinguishing children with emotional, behavioral, or developmental problems (EBDPs) from children with primarily physical chronic conditions. It also examines if a child having EBDPs is associated with perceived and unmet family support service needs and investigates public versus private health insurance's moderating effect on this association. METHODS: Using data from the National Survey of Children with Special Health Care Needs (2005/2006 and 2009/2010), this cross-sectional study uses multi-level, fixed effects logistic regression. RESULTS: When compared to CSHCN with no EBDPs, parents of CSHCN with EBDPs report greater need for all family support services and greater rates of unmet need for all support services. This pattern of greater need for CSHCN with EBDPs versus those without is similar among those with public and private health insurance. Among CSHCN with family support needs, however, the pattern differs. For CSHCN with EBDPs, having public insurance is associated with lower probabilities of unmet needs compared to private insurance. For CSHCN without EBDPs, having public insurance has a mixed effect on probability of reporting unmet need. CONCLUSION: Having EBDPs and public insurance is associated with increased perceived need, but public insurance also confers particular benefit for children with EBDPs.
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Servicios de Salud del Niño , Niños con Discapacidad , Niño , Estudios Transversales , Atención a la Salud , Encuestas de Atención de la Salud , Accesibilidad a los Servicios de Salud , Necesidades y Demandas de Servicios de Salud , Humanos , Seguro de Salud , Estados UnidosRESUMEN
Purpose: Community-based social work with families and youth with complex behavioral health needs highlights challenges to incorporating empirical evidence into routine practice. This article presents a framework for integrating evidence in community-based Systems of Care for these children and their families.Method: This article reviews research on various approaches to integrating evidence into children's behavioral health and community-based care and contextualizes it within dominant paradigms of Systems of Care (SoC) and Wraparound principles.Results: Based on this review, this article proposes the Evidence-Based Practice in Systems of Care (EBP in SoC) model. The model describes how to incorporate evidence into every aspect of community-based SoCs for children with mental health concerns.Discussion and Conclusion: Discussion of the model will focus on implications of using the framework for practitioners, mental health organizations, communities, and state and federal administration and policymaking.
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Salud Mental , Servicio Social , Adolescente , Niño , Práctica Clínica Basada en la Evidencia , HumanosRESUMEN
BACKGROUND: Racial/ethnic disparities are persistent in referrals and removals of children into child welfare systems. Yet, less is known about disparities in reunification, and how system factors may contribute to more equitable outcomes for families of color. OBJECTIVE: This study examined racial/ethnic disparities in reunification rates across U.S. child welfare systems controlling for child- and system-factors. PARTICIPANTS AND SETTING: Data for this study came from the 2017 Adoption and Foster Care Analysis and Reporting System (AFCARS). We utilized a subsample of n = 284,382 children ages 0-5. METHODS: We used a bottom-up model building-approach to examine child- and system-factors associated with reunification. A series of multilevel models were run. RESULTS: Less than 3% of the variance in reunification occurred between state child welfare systems. Native American children had lower odds of reunification than White children (AOR = 0.87, p < .001), while Hispanic children had higher odds of reunification (AOR = 1.08, p < .001). Random effects were present for race/ethnicity and interaction terms between race/ethnicity and parental drug use were significant. CONCLUSIONS: Racial/ethnic disparities are present in reunification, though these may vary across child welfare systems. Thus, future research could examine state systems that have better outcomes for families of color and examine factors that might explain these relationships.