Measuring Racial/Ethnic Disparities in Mental Health Service Use Among Children Referred to the Child Welfare System

Kim, Minseop; Garcia, Antonio R.

doi:10.1177/1077559516656397

Cited by 29 publications

(6 citation statements)

References 19 publications

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“…This study did not replicate racial disparities in service provision reported in previous studies (Kim & Garcia, 2016). Moves might trigger assessment and service planning processes resulting in a higher level of services across all groups, diminishing racial inequities.…”

Section: Discussioncontrasting

confidence: 99%

“…Concerns about racial inequities in service provision have also been raised. Latino and African American youth identified with mental health needs appear underserved relative to non-Hispanic white youth (Stein et al, 2016), potentially receiving services less than half as often (Kim & Garcia, 2016).…”

Section: Provision Of Mental Health Services In Out-of-home Carementioning

confidence: 99%

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Mental health services and psychotropic medications provided to children at risk for placement instability in foster care

Leathers

Voort

Melka-Kaffer

2021

Developmental Child Welfare

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Children at risk for placement instability are subpopulation in out-of-home care with a critical need for enhanced mental health services, but little is known about the types and adequacy of the mental services they receive. This descriptive study sought to identify the types of mental health services and psychotropic medications provided to children with a risk for moves, foster parents’ perceptions of their adequacy, consistency of therapy services with evidence-based models, and racial and gender differences in service provision. Foster parents completed telephone surveys for a randomly selected sample of 144 children aged 8–14 in specialized or traditional family foster care with a history of placement moves or hospitalizations in a large state in the US. Over two-thirds of children were reported to have mental health diagnoses, with ADHD most frequent (52%). Most children with a diagnosis received psychotherapy (75%) and psychotropic medications (90%). The majority did not receive additional services. A quarter received therapy supporting use of behavioral interventions in foster homes, with 40% of foster parents reporting this was inadequate. Additionally, half reported inadequate initial training. No racial differences in services were reported. However, girls were more likely to receive therapy described as trauma-focused than boys (30.9% and 5.6%, respectively); more boys received treatment for anger (17%) and psychotropic medication (60%). Findings indicate that children at risk for multiple moves receive a high level of services, but questions are raised about the content and adequacy of these services. Evidence-based psychosocial interventions are needed to support positive outcomes and potentially reduce psychotropic medication use.

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Section: Discussioncontrasting

confidence: 99%

Section: Provision Of Mental Health Services In Out-of-home Carementioning

confidence: 99%

Mental health services and psychotropic medications provided to children at risk for placement instability in foster care

Leathers

Voort

Melka-Kaffer

2021

Developmental Child Welfare

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“…Microsoft Excel was used to compute simple absolute and relative disparities for pairwise comparisons and summary measures of inequality (27,28). As socioeconomic status is comprised of ordered subgroups, a single comparison between the richest quintile and the poorest quintile was done, with the former being the reference group (12).…”

Section: Discussionmentioning

confidence: 99%

Private Health Care Market Shaping and Equity in Childhood Diarrhea Treatment: Evidence From Data Analysis of an ORS and Zinc Scale-up Program in Eight States Across Nigeria 

Braimoh¹,

Danat

Abubakar

et al. 2020

Preprint

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Background: Nearly 90,000 under-five children die from diarrhoea annually in Nigeria. Over 90% of the deaths can be prevented with oral rehydration salt (ORS) and zinc treatment but coverage nationally was less than 34% for ORS and 3% for zinc with wide inequities. A program was implemented in eight states to address critical barriers to the optimal functioning of the health care market to deliver these treatments. However, it has been argued that initiatives that engage the private sector may worsen inequities due to their profit motive.Methods: Changes in disparities in the coverage of ORS and zinc treatments by socioeconomic strata and geographical location were assessed using data from cross-sectional baseline and endline surveys.Results: At baseline, 28% (95% CI: 22 - 35%) of children with diarrhoea from the poorest wealth quintile received ORS compared to 50% (95% CI: 52 - 58%) from the richest. This inequality reduced at endline as ORS coverage increased by 21%-points (P = 0.000) for the poorest and 17%-points (P = 0.000) for the richest. Zinc coverage increased significantly for both quintiles at endline from an equally low baseline coverage level. Consistent with the findings of the pairwise comparison of the poorest and the richest, the summary measure of disparity across all wealth quintiles showed a narrowing of inequities from baseline to endline. Concentration curves shifted towards equality for both treatments, concentration index declined from 0.1012 to 0.0480 for ORS and from 0.2640 to 0.0567 for zinc. Disparities in ORS and zinc coverage between rural and urban at both time points was insignificant except that the use of zinc in the rural at endline was significantly higher at 38% (95%CI: 35 - 41%) compared to 29% (95%CI: 25 - 33%) in the urban.Conclusion: The results show a pro-rural improvement in coverage and a reduction in coverage inequities across wealth quintiles from baseline to endline. This gives an indication that initiatives focused on shaping healthcare market systems may be effective in reducing health coverage gaps without detracting from equity as a health policy objective.

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“…This wide need but narrow behavioral health service utilization for child welfare-involved youth has been well documented and is particularly critical for children and youth of color (Garcia, Palinkas, Snowden, & Landsverk, 2013; Garland et al, 2000; Garland, Landsverk, & Lau, 2003; Horwitz et al, 2012; Kim & Garcia, 2016). Based on these service access and utilization gaps, cross-system collaboration (CSC) has advanced as an integral element of trauma-informed care (TIC).…”

mentioning

confidence: 99%

Measuring collaboration across children’s behavioral health and child welfare systems.

Crandal¹,

Martin²,

Hazen³

et al. 2019

Psychological Services

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A commonly emphasized component of trauma-informed care is the practice of building cross-system collaboration (CSC). While existing research on CSC states numerous benefits and barriers associated with increasing collaboration between systems, there is limited empirical understanding on how to define and measure collaboration between county systems of care. The current study presents the psychometric evaluation of scores from the Perceptions of Overarching Cross-System Collaboration–Child Welfare and Behavioral Health Systems (POCSC-CW/BH), a 6-item self-report instrument completed by system administrative leadership and direct service providers, administered within child welfare and children’s behavioral health systems in 6 California counties. Psychometric analysis demonstrated good support of internal consistency, as well as the factorial, convergent, and discriminant validity of scores produced by the tool. There was also evidence for content validity. System-level analyses showed within-county child welfare, and children’s behavioral health system staff reported similar perceptions of CSC in 5 of 6 counties, whereas POCSC-CW/BH scores across counties showed variability. Exploratory results revealed CSC scores varied by staff role in each system. In general, the POCSC-CW/BH is a promising instrument that adds to a limited array of practical empirically supported measurement tools for measuring CSC between child welfare and children’s behavior health systems. The study limitations and implications for CSC measurement and trauma-informed practice are discussed.

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Measuring Racial/Ethnic Disparities in Mental Health Service Use Among Children Referred to the Child Welfare System

Cited by 29 publications

References 19 publications

Mental health services and psychotropic medications provided to children at risk for placement instability in foster care

Mental health services and psychotropic medications provided to children at risk for placement instability in foster care

Private Health Care Market Shaping and Equity in Childhood Diarrhea Treatment: Evidence From Data Analysis of an ORS and Zinc Scale-up Program in Eight States Across Nigeria

Measuring collaboration across children’s behavioral health and child welfare systems.

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Measuring Racial/Ethnic Disparities in Mental Health Service Use Among Children Referred to the Child Welfare System

Cited by 29 publications

References 19 publications

Mental health services and psychotropic medications provided to children at risk for placement instability in foster care

Mental health services and psychotropic medications provided to children at risk for placement instability in foster care

Private Health Care Market Shaping and Equity in Childhood Diarrhea Treatment: Evidence From Data Analysis of an ORS&nbsp;and Zinc Scale-up Program in Eight States Across Nigeria&nbsp;

Measuring collaboration across children’s behavioral health and child welfare systems.

Contact Info

Product

Resources

About

Private Health Care Market Shaping and Equity in Childhood Diarrhea Treatment: Evidence From Data Analysis of an ORS and Zinc Scale-up Program in Eight States Across Nigeria