Snowden Lonnie R, Wallace Neal, Cordell Kate, Graaf Genevieve
School of Social Welfare, University of California, Berkeley, CA, USA,
J Ment Health Policy Econ. 2017 Sep 1;20(3):137-145.
Latino child populations are large and growing, and they present considerable unmet need for mental health treatment. Poverty, lack of health insurance, limited English proficiency, stigma, undocumented status, and inhospitable programming are among many factors that contribute to Latino-White mental health treatment disparities. Lower treatment expenditures serve as an important marker of Latino children's low rates of mental health treatment and limited participation once enrolled in services.
We investigated whether total Latino-White expenditure disparities declined when autonomous, county-level mental health plans receive funds free of customary cost-sharing charges, especially when they capitalized on cultural and language-sensitive mental health treatment programs as vehicles to receive and spend treatment funds. Using Whites as benchmark, we considered expenditure pattern disparities favoring Whites over Latinos and, in a smaller number of counties, Latinos over Whites.
Using segmented regression for interrupted time series on county level treatment systems observed over 64 quarters, we analyzed Medi-Cal paid claims for per-user total expenditures for mental health services delivered to children and youth (under 18 years of age) during a study period covering July 1, 1991 through June 30, 2007. Settlement-mandated Medicaid's Early Periodic Screening, Diagnosis and Treatment (EPSDT) expenditure increases began in the third quarter of 1995. Terms were introduced to assess immediate and long term inequality reduction as well as the role of culture and language-sensitive community-based programs.
Settlement-mandated increased EPSDT treatment funding was associated with more spending on Whites relative to Latinos unless plans arranged for cultural and language-sensitive mental health treatment programs. However, having programs served more to prevent expenditure disparities from growing than to reduce disparities.
EPSDT expanded funding increased proportional expenditures for Whites absent cultural and language-sensitive treatment programs. The programs moderate, but do not overcome, entrenched expenditure disparities. These findings use investment in mental health services for Latino populations to indicate treatment access and utilization, but do not explicitly reflect penetration rates or intensity of services for consumers.
New funding, along with an expectation that Latino children's well documented mental health treatment disparities will be addressed, holds potential for improved mental health access and reducing utilization inequities for this population, especially when specialized, culturally and linguistically sensitive mental health treatment programs are present to serve as recipients of funding.
To further expand knowledge of how federal or state funding for community based mental health services for low income populations can drive down the longstanding and considerable Latino-White mental health treatment disparities, we must develop and test questions targeting policy drivers which can channel funding to programs and organizations aimed at delivering linguistically and culturally sensitive services to Latino children and their families.
拉丁裔儿童群体规模庞大且不断增长，他们对心理健康治疗有着巨大的未满足需求。贫困、缺乏医疗保险、英语水平有限、耻辱感、无证身份以及不友好的服务项目等诸多因素导致了拉丁裔与白人在心理健康治疗方面的差距。较低的治疗支出是拉丁裔儿童心理健康治疗率低以及参保后参与度有限的一个重要标志。
我们调查了，当县级自主心理健康计划获得免除常规费用分摊的资金时，尤其是当它们利用文化和语言敏感型心理健康治疗项目作为接收和使用治疗资金的载体时，拉丁裔与白人之间的总支出差距是否会缩小。以白人为基准，我们考虑了有利于白人而非拉丁裔的支出模式差异，以及在少数县中有利于拉丁裔而非白人的支出模式差异。
我们使用分段回归分析中断时间序列，对在64个季度内观察到的县级治疗系统进行分析，研究了1991年7月1日至2007年6月30日期间医疗补助计划为18岁以下儿童和青少年提供心理健康服务的人均总支出支付的索赔。1995年第三季度开始了结算规定的医疗补助计划早期定期筛查、诊断和治疗（EPSDT）支出增加。引入了一些术语来评估即时和长期的不平等减少情况，以及文化和语言敏感型社区项目的作用。
结算规定的EPSDT治疗资金增加与白人相对于拉丁裔的支出增加相关，除非计划安排了文化和语言敏感型心理健康治疗项目。然而，这些项目更多地是防止支出差距扩大，而不是缩小差距。
在没有文化和语言敏感型治疗项目的情况下，EPSDT扩大资金增加了白人的比例支出。这些项目缓和了，但没有克服根深蒂固的支出差距。这些发现利用对拉丁裔人群心理健康服务的投资来表明治疗机会和利用率，但没有明确反映消费者的服务渗透率或服务强度。
新的资金，以及解决拉丁裔儿童心理健康治疗差距有据可查这一期望，有可能改善该人群的心理健康服务可及性并减少利用不平等，特别是当有专门的、文化和语言敏感型心理健康治疗项目作为资金接收方时。
为了进一步扩大对联邦或州为低收入人群提供社区心理健康服务的资金如何能够缩小长期存在且显著的拉丁裔与白人心理健康治疗差距的认识，我们必须制定和测试针对政策驱动因素的问题，这些因素可以将资金引导至旨在为拉丁裔儿童及其家庭提供语言和文化敏感型服务的项目和组织。
