文章基本信息

标题：Racial/Ethnic Minority Children’s Use of Psychiatric Emergency Care in California’s Public Mental Health System
本地全文：下载
作者：Lonnie R. Snowden ; Mary C. Masland ; Anne M. Libby 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2008
卷号：98
期号：1
页码：118-124
DOI：10.2105/AJPH.2006.105361
语种：English
出版社：American Public Health Association
摘要：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. Although research on racial/ethnic and cultural disparities in children’s mental health treatment has grown and become ever more rigorous, 1 ^, 2 little attention has been paid to services that attempt to stabilize children who are in crisis. Excess minority use of emergency care, if it occurs, is important to document and understand, because emergency services do not promote the monitoring of troubling conditions, access to all necessary treatments, or continuity of care. 3 Racial/ethnic minority children are at increased risk for factors that lead to psychiatric emergency services use. Adversity increases children’s and youths’ chances of experiencing a crisis 4 ^, 5 and minority children are more likely to face certain types of adversity. For example, socioeconomic disadvantage, 3 residence in poor neighborhoods, 6 racism, 7 acculturative stress, 8 and care by family members who are themselves under pressure and distressed 9 befall minority children especially. Moreover, minority children are underrepresented in alternative sources of specialized mental health assistance that might avert a crisis, including outpatient treatment. 10 ^, 11 These factors contribute to suicidal ideation and suicide attempts, the most frequent reason children use emergency services. 12 ^, 13 Rates of suicidal behavior are higher among Latino, Asian American/Pacific Islander, and American Indian/Alaska Native children than among White children. Among African American children, suicide-related problems occur at a lower rate than among White children, but they are increasing. 14 Conversely, personal 15 ^, 16 and community strengths 17 ^, 18 protect minority children, which moderates the impact of these stressors and reduces the risk of requiring emergency services. The limited research available to date indicates that minority children are increasingly using emergency services, 19 but the evidence is mixed as to whether they are overrepresented. We examined racial/ethnic disparities in psychiatric emergency services use in a large, racially/ethnically diverse, multiyear sample of participants younger than 18 years in California’s public mental health care services system. Services were funded by MediCal, California’s Medicaid program. Children qualify for Medi-Cal if their family’s income falls below a legislatively mandated cutoff: $19350 for a family of 4 in 2005. 20 Under Medi-Cal, children’s psychiatric emergency services are divided into 2 categories: crisis stabilization and crisis intervention. Crisis stabilization services are usually hospital based, and they are designed for the most serious crises. These services are provided in a hospital or in another kind of 24-hour health care facility, and they aim to alleviate the need for inpatient care. Compared with other crisis services, crisis stabilization is longer and more intensive. Crisis intervention services are designed for less-urgent crises. They are provided in the community and generally include assessment, evaluation, collateral care, and therapy. Crisis intervention services are for clients who need urgent assistance but whose crisis is not severe enough to warrant confinement or removal from the community. We considered both crisis stabilization and crisis intervention services at 2 levels of use. The first level was initial use—whether crisis intervention or crisis stabilization services were used at all during the 3-year period of observation. The second level we considered was how frequently crisis intervention or crisis stabilization services were used after initial use. We sought to address the following 2 questions: Are minority children more likely than White children to use crisis stabilization and crisis intervention services? Are there racial disparities in the frequency of crisis service utilization?