State and Other People's Children: The Impact of State Health Policies on Pathways to Ambulatory Mental Health Services for Children in Child Welfare Final rept. (Apr. 15, 2003-Jan. 14, 2004)

摘要

Children in the child welfare system have high mental health needs, and depend largely upon Medicaid to finance access to mental health care. The effects of Medicaid managed behavioral healthcare policies implemented in various ways by states on mental health use by this high-need population are unknown. The National Survey of Child and Adolescent Well-Being provides individual-level data for 6,231 children in the child welfare system. The Caring for Children in Child Welfare study uses key informant interviews to obtain county-level Medicaid policy information. We merged these data files with the Area Resource File, and analyzed relationships between countylevel policies and childrens mental health utilization using a three-stage nested logit model. Around 37% of all children had a clinical score on the Child Behavior Checklist. Less than a fifth saw a specialty mental health provider. Multiple logistic regression showed older age, out-of-home placement, higher physical and emotional morbidity, and having a college-educated caregiver to be associated with higher odds of receiving mental health care. Children living in counties with high concentrations of child psychiatrists had higher odds of mental health service use; their odds declined if they lived in counties with high concentrations of pediatricians. Children placed out-of-home in counties with behavioral carve-outs had higher odds of use of mental health care. Fee-for-service provider reimbursement was associated with higher odds of mental health services use.