Disparities in receipt of specialty services among children with mental health need enrolled in the CMHI

Examining English- and Spanish-Speaking Therapist Behaviors in Parent–Child Interaction Therapy

Parent–child interaction therapy (PCIT) is a best-practice treatment for behavior problems in young children. In PCIT, therapists coach parents during in-vivo interactions to strengthen the parent–child relationship and teach parents effective ways of managing difficult child behaviors. Past research has found that different therapist coaching styles may be associated with faster skill acquisition and improved parent engagement. However, most research examining therapist behaviors has been conducted with English-speaking families, and there is limited research examining therapist behaviors when working with Spanish-speaking clients. In this study, English- and Spanish-speaking therapists’ coaching behaviors (e.g., directive versus responsive) were examined, as well as their association with client outcomes, including speed of parental skill acquisition and treatment completion. Results suggested that coaching styles varied significantly between sessions conducted in Spanish versus English. In Spanish sessions, therapists had more total verbalizations than in English sessions and demonstrated higher rates of both total directive and responsive coaching. Responsive coaching was found to predict treatment completion across groups, while directive coaching was not. Directive and responsive coaching were not found to predict the rate of parental skill acquisition. Implications regarding the training of therapists and emphasizing cultural considerations are discussed.

Community Adversity and Utilization of Psychotropic Medications Among Children in Foster Care

The objective of this study was to examine the association between community adversity and psychotropic use among children in foster care in one US state. This study uses a cross-sectional design integrated foster care and Medicaid administrative data with data from Kids Count, the US Census, and the Area Health Resource File. There were 4,334 children ages 5-18 in foster care in 2014. We used K-means cluster analysis grouped state counties using indicators of school performance, juvenile justice involvement, and food insecurity. Chi-square tests assessed significance between psychotropic medication and community adversity cluster. A generalized linear mixed model assessed the relationship between psychotropic use and community adversity cluster, accounting for individual-level and cluster-level factors. Children in foster care living in high adversity communities were significantly less likely to use psychotropic medication (p < .0001). Future research can investigate the specific community factor influencing judicious use of psychotropic medication and the impact on children outcomes.

Public Health Coverage and Access to Mental Health Care for Youth with Complex Behavioral Healthcare Needs

Drawing upon the National Survey of Children with Special Healthcare Needs (2009/2010), multilevel logistic regression analysis assessed the relationship between parent report of a youth having an emotional, behavioral, or developmental problem (EBDP), their level of reported functional limitations, and parents' report of unmet mental health care needs and experience with cost-barriers to accessing needed healthcare services. Results indicate that, compared to all privately insured youth with special health care needs, parents of privately insured youth with EBDP are much more likely to report their child having unmet mental health care needs (OR 12.16; p < 0.001) and experiencing cost barriers to care (OR 2.37; p < 0.001). Parents of privately insured youth with EBDP with functional limitations are even more likely to report these concerns (Unmet Mental Health Needs: OR 17.09; p < 0.001; Cost Barriers: OR 5.77; p < 0.001). However, findings suggest that having public insurance is associated with reductions in the odds of having unmet needs for youth with SED by 50%. Public insurance and dual coverage is associated with reductions in the odds of encountering cost barriers to care by almost 50% for children with EBDP, and by more 50% for youth with EBDP and functional impairments.

Road to the Future: Priorities for Child Health Services Research

BACKGROUND

Prior health services research (HSR) agendas for children have been published, but major ones are now over 15 years old and do not reflect augmented understanding of the drivers and determinants of children's health; recent changes in the organization, financing, and delivery of health care; a growing emphasis on population health; and major demographic shifts in the population. A policy-relevant research agenda that integrates knowledge gained over the past 2 decades is essential to guide future child HSR (CHSR). We sought to develop and disseminate a robust, domestically focused, policy-oriented CHSR agenda.

METHODS

The new CHSR agenda was developed through a series of consultations with leaders in CHSR and related fields. After each round of consultation, the authors synthesized the previous experts' guidance to help inform subsequent discussions. The multistep process in generation of the agenda included identification of major policy-relevant research domains and specification of high-value research questions for each domain. Stakeholders represented in the discussions included those with expertise in child and family advocacy, adult health, population health, community development, racial and ethnic disparities, women's health, health economics, and government research funders and programs.

RESULTS

In total, 180 individuals were consulted in developing the research agenda. Six priority domains were identified for future research, including both enduring and emerging emphases: 1) framing children's health issues so that they are compelling to policy-makers; 2) addressing poverty and other social determinants of child health and wellbeing; 3) promoting equity in population health and health care; 4) preventing, diagnosing, and treating high priority health conditions in children; 5) strengthening performance of the health care system; and 6) enhancing the CHSR enterprise. Within these 6 domains, 40 specific topics were identified as the most pertinent for future research. Three overarching and crosscutting themes that affect research across the domains were also noted: the need for syntheses to build on the current, and sometimes extensive, evidence base to avoid duplication; the interrelated nature of the domains, which could lead to synergies in research; and the need for multidisciplinary collaborations in conducting research because research studies will look beyond the health sector.

CONCLUSIONS

The priorities presented in the agenda are policy-oriented and include a greater emphasis on how findings are framed and communicated to support action. We expect that the agenda will be useful for immediate uptake by investigators and research funders.

Utilization of Mental Health Services After Mild Pediatric Traumatic Brain Injury

BACKGROUND

Mild traumatic brain injury injuries (mTBIs), including concussions, represent >2 million US pediatric emergency department visits annually. Post-mTBI mental health symptoms are prominent and often attributed to the mTBI. This study examined whether individuals seeking post-mTBI mental health care had previous mental health diagnoses or a new onset of such disorders, and determined if mental health care utilization differed by race/ethnicity.

METHODS

Retrospective cohort study, using the Medicaid Marketscan claims national dataset (2007-2012). Utilization of mental health services 1 year before and 1 year after mTBI was compared between children with and without mental health diagnoses before injury. Primary outcome was receipt of post-mTBI outpatient mental health care.

RESULTS

A total of 31 272 children 20 years or younger were included, 8577 (27%) with mental health diagnoses before their mTBI and 22 695 without one. After injury, children without previous mental health disorders increased mental health services utilization; however, most (86%) postinjury mental health care was received by children with previous mental health disorders. Having a mental health diagnosis pre-mTBI was the most important risk factor for receiving post-mTBI mental health care (odds ratio 7.93, 95% confidence interval 7.40-8.50). Hispanic children were less likely to receive post-mTBI mental health care.

CONCLUSIONS

mTBI was associated with increased utilization of mental health services but most of these services were received by children with previous mental health disorders. Our documentation of racial/ethnic disparities in mental health care utilization reemphasize the importance of providing individualized, culturally, and linguistically competent care to improve outcomes after mTBI for all children.