Jolles M P, Wells R
School of Social Work, University of Southern California, Los Angeles, USA.
School of Public Health, Management, Policy and Community Health, University of Texas, Houston, USA.
Child Care Health Dev. 2017 Mar;43(2):192-201. doi: 10.1111/cch.12384. Epub 2016 Jul 28.
Many children in contact with child welfare agencies do not receive needed health services. These agencies have used participatory decision making (PDM) practices as a way to increase families' use of recommended services. However, we lack evidence of whether caregiver participation in PDM increases children's use of health services. This study uses a national sample of children involved with child welfare to compare their health service use between those children serve through a PDM practice and those who did not experience it.
Cross-sectional analyses using the 2009-2010 National Survey of Child and Adolescent Well-Being. Propensity score analysis accounted for observed selection bias. PDM practice was measured as whether the caregiver was included in decision-making during service planning meetings. Health service use was measured as child's receipt of any primary or mental health care services in the past year. Primary health care need was measured using standardized measures and caseworker report. The sample was comprised of children ages 2-17 with primary or mental health needs in contact with a child welfare agency.
In the unmatched sample of 1,358 children, 14% were served through a PDM service practice, and 12% had a primary health care and 37% a mental health need. Families served through PDM were also reported by caseworkers as more cooperative during the child welfare investigation, and with fewer reports of domestic violence and agency re-referrals (P < 0.05). Analyses using matched samples showed that for primary health care, 59% of PDM children received services compared with 40% for non-PDM children (P = 0.004). Group differences were not significant for mental health services.
Lower-risk families were more likely to be served through PDM which was positively associated with child use of primary health services. Inclusion of caregivers in decision making may not be sufficient to overcome barriers to children's mental health service use.
许多与儿童福利机构有接触的儿童未获得所需的健康服务。这些机构采用参与式决策（PDM）做法，以此增加家庭对推荐服务的利用。然而，我们缺乏关于照料者参与PDM是否能增加儿童对健康服务利用的证据。本研究使用全国范围内与儿童福利相关的儿童样本，比较通过PDM做法接受服务的儿童与未经历该做法的儿童的健康服务利用情况。
使用2009 - 2010年全国儿童和青少年福祉调查进行横断面分析。倾向得分分析考虑了观察到的选择偏差。PDM做法通过照料者在服务规划会议期间是否参与决策来衡量。健康服务利用通过儿童在过去一年中接受任何初级或心理健康护理服务来衡量。初级医疗保健需求使用标准化测量方法和个案工作者报告来衡量。样本包括2至17岁有初级或心理健康需求且与儿童福利机构有接触的儿童。
在1358名儿童的未匹配样本中，14%通过PDM服务做法接受服务，12%有初级医疗保健需求，37%有心理健康需求。个案工作者还报告称，通过PDM接受服务的家庭在儿童福利调查期间更合作，家庭暴力报告和机构再次转介的情况更少（P < 0.05）。使用匹配样本的分析表明，对于初级医疗保健，59%的PDM儿童接受了服务，而非PDM儿童为40%（P = 0.004）。心理健康服务的组间差异不显著。
低风险家庭更有可能通过PDM接受服务，这与儿童对初级健康服务的利用呈正相关。让照料者参与决策可能不足以克服儿童使用心理健康服务的障碍。
