Racial/Ethnic Minority Children’s Use of Psychiatric Emergency Care in California’s Public Mental Health System

Abstract

Objectives. We examined rates and intensity of crisis services use by race/ethnicity for 351174 children younger than 18 years who received specialty mental health care from California’s 57 county public mental health systems between July 1998 and June 2001. Methods. We used fixed-effects regression for a controlled assessment of racial/ethnic disparities in children’s use of hospital-based services for the most serious mental health crises (crisis stabilization services) and community-based services for other crises (crisis intervention services). Results. African American children were more likely than were White children to use both kinds of crisis care and made more visits to hospital-based crisis stabilization services after initial use. Asian American/Pacific Islander and American Indian/Alaska Native children were more likely than were White children to use hospital-based crisis stabilization services but, along with Latino children, made fewer hospital-based crisis stabilization visits after an initial visit. Conclusions. African American children used both kinds of crisis services more than did White children, and Asian Americans/Pacific Islander and American Indians/Alaska Native children visited only when they experienced the most disruptive and troubling kind of crises, and made nonrecurring visits.

Trends in Pediatric Visits to the Emergency Department for Psychiatric Illnesses

“…We decided a priori to include age, sex, race, ethnicity, region, urban status, and year in the model, as they have been previously demonstrated to be associated with differences in both ED and psychiatric care. 3,6,7,11,12,16,[19][20][21][22][23][24] For the length of stay (LOS) analysis as our secondary outcome, we tested for trend the median visit length. Median LOS is used in place of the mean LOS as values were not normally distributed.…”

Common and Costly Hospitalizations for Pediatric Mental Health Disorders

“…9 Although there is a rich literature on pediatric mental health care outpatient utilization and there are statewide data for 2 states on predictors of inpatient use among publicly insured children, 10,11 no studies have examined which specific inpatient mental health diagnoses are the most common or the most costly, and there are no nationally representative descriptions of pediatric mental health hospitalizations.…”

Emergency health care use and follow-up among sociodemographic groups of children who visit emergency departments for mental health crises

“…We developed multivariable Cox proportional hazard models to investigate the effect of predictor variables on time to a return emergency department visit. We included in the models variables hypothesized to predict time to return (age and sex, 19 First Nations and socioeconomic status, 3 We assessed the reduced model by tests of proportional hazards assumptions and deviance residual diagnostics. Hazard ratios (HR) and 95% CIs are reported.…”

“…3,4 Minority children are less likely than white children to have received mental health treatment before an emergency department visit, 3,4 and uninsured children are less likely to receive an urgent mental health evaluation when needed. 4 Other studies, however, have shown no relation between sociodemographic status and mental health care, 5,6 and it may be that different health system characteristics (e.g., pay-for-service, insurance coverage, publicly funded care) interact with sociodemographic status to influence how mental health resources are used.…”