Medicaid data contain International Classification of Diseases, Clinical Modification (ICD-9-CM) codes indicating maltreatment, yet there is a little information on how valid these codes are for the purposes of identifying maltreatment from health, as opposed to child welfare, data. This study assessed the validity of Medicaid codes in identifying maltreatment. Participants (n = 2,136) in the first National Survey of Child and Adolescent Well-Being were linked to their Medicaid claims obtained from 36 states. Caseworker determinations of maltreatment were compared with eight sets of ICD-9-CM codes. Of the 1,921 children identified by caseworkers as being maltreated, 15.2% had any relevant ICD-9-CM code in any of their Medicaid files across 4 years of observation. Maltreated boys and those of African American race had lower odds of displaying a maltreatment code. Using only Medicaid claims to identify maltreated children creates validity problems. Medicaid data linkage with other types of administrative data is required to better identify maltreated children.

Preschoolers are receiving psychotropic medications despite limited evidence supporting safety or efficacy. Future research should focus on implementing medication use practice parameters in infant and toddler clinics, and expanding psychosocial interventions for young children with behavioral problems.

American Indian and Alaska Native (AI/AN) populations report poor physical and mental health outcomes while tribal health providers and the Indian Health Service (IHS) operate in a climate of significant under funding. Understanding how the Patient Protection and Affordable Care Act (ACA) affects Native American tribes and the IHS is critical to addressing the improvement of the overall access, quality, and cost of health care within AI/AN communities. This paper summarizes the ACA provisions that directly and/or indirectly affect the service delivery of health care provided by tribes and the IHS.

Few scholars have considered the racial socialization that Black mothers offer to their daughters on racial discrimination and violence or how mothers’ other social identities (social class and ethnicity) may influence their discourse on these topics. To address this gap, we used consensual qualitative research methods to explore the racial socialization that 47 Black college women recalled from their mothers on racial discrimination and violence during their formative years. The following themes emerged: (a) the nature of Black mothers’ socialization on racial discrimination (consistent messaging, messaging focused on sons, more socialization in response to police shootings, anti-Black messaging from immigrant mothers, and absence of messages) and (b) the ways that mothers socialized their daughters to respond to racial discrimination (self-advocacy, get home safe, code switching, and take the high road). Participants described how their mothers’ socialization messages reflected their personal race-related beliefs and experiences including perceptions of the United States racial climate. Our findings highlight the need for socialization in Black family contexts that addresses the unique and intersectional experiences of Black girls. In particular, scholars and practitioners must draw attention to how racism and sexism contribute to the state-sanctioned violence that Black women and girls experience.

Objective Children with histories of abuse or neglect are the most expensive child population to insure for their mental health needs. This paper quantifies the magnitude of Medicaid expenditures incurred on the purchase of psychotropic drugs for these children. Methods Child participants (N=4445) in the National Survey of Child and Adolescent Well-Being (NSCAW) – consisting of children investigated for suspected abuse and neglect – were linked to their Medicaid claims from 36 states. Expenditures on psychotropic mediations between the NSCAW sample and a propensity score-matched comparison sample were compared using a two-part regression of logistic and generalized linear models. Results Children surveyed in NSCAW had twice the odds of psychotropic drug use, and $190 higher mean annual expenditures on psychotropic drugs than those in the comparison sample. Increased expenditures on antidepressants and antimanic drugs were the primary drivers of these increased expenditures. Male gender and white race/ethnicity were associated with significantly increased expenditures. Children in primary care case management had $325 lower expenditures than those in fee-for-service Medicaid. Among NSCAW children alone, male gender, older age, being in poorer health, and scoring in the clinical range of the Child Behavior Checklist all increased expenditures on psychotropic drugs. Conclusions Medicaid agencies should focus their cost containment strategies on antidepressants and antimanic drugs, consider expanding primary care case management arrangements, and expand use of instruments such as the Child Behavior Checklist to identify and treat high-need children.