Lonnie Roscoe Snowden
University Of California Berkeley
Project start date: 2010-05-01
Project end date: 2013-01-31
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Grants awarded to Lonnie Roscoe Snowden
CAN MEDICAID BENEFITS REDUCE ACCESS DISPARITIES FOR MINORITY CHILDREN & YOUTH?
Lonnie Roscoe Snowden, Professor
University Of California Berkeley, 2150 Shattuck Avenue, Room 313, Berkeley, Ca 94704-5940
Grant 1R01MH083693-01A2 from National Institute Of Mental Health
Abstract: The study goal is to examine the aggressive enforcement of Medicaid´s (Medi-Cal´s) Early Periodic Screening Diagnosis and Treatment program (EPSDT) to learn whether reducing important structural barriers to public mental health care by providing generous financing, increasing treatment capacity, and engaging with community-based programs and organizations will bring about the desired policy effect of equalizing spending and treatment patterns among low-income white and ethnic minority children and youth. Study aims are 1) Estimate the extent to which California´s EPSDT mental health program expansion reduced disparities in spending for African American, Latino and Native American Medi-Cal enrolled children and youth. Determine how much reduction in spending disparities was immediate and how much it constituted minority-white convergence in trends. 2) Estimate the extent to which California´s enforcement of EPSDT mental health services reduced disparities in access (measured by overall penetration rates; outpatient treatment penetration rates; and crisis treatment penetration rates) for African American, Latino and Native American Medi-Cal enrolled children and youth. Determine how much reduction in access disparities was immediate and how much it constituted minority-white convergence in trends. 3) Estimate for each dependent measure described in 1 and 2 above the extent to which reduced minority-white disparities was associated with a) increases in total provider supply and Spanish-speaking provider supply; and b) increased engagement with community-based organizations including those with an ethnic minority focus. Using panel data multivariate regression methods in a kind of "interrupted time-series" approach (Shadish, Cook & Campbell, 2002), we control for factors correlated with aggressive EPSDT enforcement that could confound our assessment of its impact on cost and access disparities. We will observe costs and penetration rates before and after EPSDT enforcement over 48 quarters (July 1992 - June 2004) and across the 57 California county mental health plans. Since our focus is on changes in disparities between ethnic minorities and whites over time, any potential confounds must differentially affect ethnic minorities or whites to influence study results. To further test hypotheses, we contrast disparities in sub-samples minimally affected by, and unaffected by, EPSDT enforcement. Medi-Cal Specialty Mental Health Claims data and Medi-Cal enrollment data obtained from the California Department of Mental Health will be used. The lack of mental health access and treatment for children and adolescents is a serious public health problem raised by the Surgeon General in his 2000 report. Low access is especially pronounced among ethnic minority populations for whom mental illness is becoming a significant problem in May 2007, the CDC issued a report stating that suicide was the fourth leading cause of death among youth, and that the highest rates have occurred among minority populations1. The proposed study will provide information for policymakers and administrators to understand the conditions under which existing financing and delivery systems can be levered to rapidly expand access and improve care for these children and youth. 1 Bernard SJ, Paulozzi LJ, Wallace DL; Centers for Disease Control and Prevention (CDC) (2007). Fatal injuries among children by race and ethnicity--United States, 1999-2002. MMWR Surveill Summ. May 18;56(5)1-16
Keywords: 0-11 years old; 21 year old; 21+ years old; Address; Administrator; Adolescent; Adolescent Youth; Adult; Affect; African American; Afro American; Afroamerican; Black Populations; Black or African American; CDC; California; Care, Health; Caring; Cause of Death; Centers for Disease Control; Centers for Disease Control (U.S.); Centers for Disease Control and Prevention; Centers for Disease Control and Prevention (U.S.); Characteristics; Child; Child Youth; Children (0-21); Communities; County; Data; Diagnosis; Early treatment; Enrollment; Ethnic Origin; Ethnicity; Ethnicity aspects; Event; Goals; Health Benefit; Health Expenditures; Health Planning; Health Services; Health system; Healthcare; Human, Adult; Human, Child; Improve Access; Injury; Institute of Medicine; Institute of Medicine (U.S.); Latino; Learning; Lifting; Linguistic; Linguistics; Low income; Measures; Medicaid; Medical; Medical Specialities; Mental Health; Mental Health Services; Mental Hygiene; Mental Hygiene Services; Mental disorders; Mental health disorders; Methods; Minority; NAS/IOM; Native Americans; Natural experiment; Out-patients; Outpatients; PROV; Pathway interactions; Pattern; Penetration; Play; Policies; Policy Making; Population; Programs (PT); Programs [Publication Type]; Provider; Psychiatric Disease; Psychiatric Disorder; Psychological Health; Public Health; Race; Racial Group; Reporting; Role; Rosa; Rose; Sampling; Screening procedure; Series; Specialties, Medical; Specialty; Stocks, Racial; Suicide; Surgeon; System; System, LOINC Axis 4; Testing; Time; United States; United States Centers for Disease Control; United States Centers for Disease Control and Prevention; Unspecified Mental Disorder; Youth; Youth 10-21; adult human (21+); advocacy organizations; base; black American; children; community organizations; cooking; cost; early onset; enroll; ethnic minority; ethnic minority population; fatal attempt; fatal suicide; health care expenditure; health care service; intent to die; juvenile; juvenile human; medical specialties; mental illness; neglect; pathway; programs; psychological disorder; public health medicine (field); public health relevance; racial and ethnic; racial/ethnic; safety net; screening; screenings; social role; suicidality; treatment program; trend; twenty-one year old; youngster
Relevance: The lack of mental health access and treatment for children and adolescents is a serious public health problem raised by the Surgeon General in his 2000 report. Low access is especially pronounced among ethnic minority populations for whom mental illness is becoming a significant problem: in May 2007, the CDC issued a report stating that suicide was the fourth leading cause of death among youth, and that the highest rates have occurred among minority populations1. The proposed study will provide information for policymakers and administrators to understand the conditions under which existing financing and delivery systems can be levered to rapidly expand access and improve care for these children and youth. 1 Bernard SJ, Paulozzi LJ, Wallace DL; Centers for Disease Control and Prevention (CDC) (2007). Fatal injuries among children by race and ethnicity--United States, 1999-2002. MMWR Surveill Summ. May 18;56(5):1-16
Project start date: 2010-05-01
Project end date: 2013-01-31
Budget start date: 1-MAY-2010
Budget end date: 31-JAN-2011
PFA/PA: PA-07-070
1R01MH083693-01A2 (2010): $249264
POLICIES IMPROVING NON-ENGLISH SPEAKERS´ ACCESS & CARE
Lonnie Roscoe Snowden, Professor
University Of California Berkeley, 2150 Shattuck Avenue, Room 313, Berkeley, Ca 94704-5940
Grant 5R01MH070942-04 from National Institute Of Mental Health
Abstract: Overcoming access barriers associated with limited proficiency in the English language-the "language barrier" - is expected to contribute greatly toward eliminating disparities in access to specialty mental health care. Since 1997, the California Department of Mental Health (DMH) has required that the state´s 57 county-operated mental health agencies provide information and services to Medicaid (Medi-Cal) beneficiaries in their primary language when the number of beneficiaries in the county reaches "threshold" levels defined as "3,000 beneficiaries or 5% of the Medi-Cal population, whichever is lower, whose primary language is other than English." This study will assess the impact of California´s threshold language policy requirements (TLPRs) on access and continuity of care for Medi-Cal beneficiaries ages 19-64 over a 72- month period beginning July 1997 and ending June 2003. Specific research questions are 1) Among non-English speakers, what is the impact of TLPRs on access to specialty mental health care and continuity of care? 2) How is the impact of TLPRs substituted or complemented by broader efforts to serve non-English speaking populations through hiring of bilingual providers and provision of language specific programs? Using panel data regression methods, with the county and month as the unit and period of observation, we will evaluate language-specific differences in access and continuity of care as they relate to differences in implementation of the four TLPRs as well as hiring of bilingual providers and provision of language-specific programs. At the same time, we will control for differences in county sociodemographic environments, mental health systems, as well as changes in access and continuity for English-speaking persons. The analysis will, be carried out using Medi-Cal Specialty Mental Health Claims data and Medi-Cal Eligibility data obtained from the California DMH. Other state data sources will be used to measure county and service system characteristics. Primary data will be collected from county cultural competency plans and state compliance review reports documenting each county´s implementation of the TLPRs, and the availability of bilingual providers and language-specific programs. Individual in-depth interviews will be conducted by trained bilingual interviewers with limited-English consumers to obtain their perspectives on how the TLPRs, and other county mental health activities, have helped or hindered access to and continuity of mental health care
Keywords: 21+ years old; AHCPR; AHRQ; Access to Care; Access to Health Care; Access to Healthcare; Accessibility of health care; Address; Adopted; Adult; Age; Agency for Health Care Policy and Research; Agency for Healthcare Research and Quality; Annual Reports; Availability of Health Services; Awareness; Awarenesses; California; Care, Health; Caring; Characteristics; Civil Rights; Communities; Complement; Complement Proteins; Continuity of Care; Continuity of Patient Care; Continuum of Care; County; Data; Data Sources; Department of Health and Human Services; Department of Health and Human Services (U.S.); Document Type; ELIG; Economics; Eligibility; Eligibility Determination; English Language; Environment; Ethnic Origin; Ethnicity; Ethnicity aspects; Funding; HHS; Hand; Health Planning; Health Services Accessibility; Health system; Healthcare; Heterogeneity, Population; Hour; Human, Adult; IT Systems; Improve Access; Individual; Information Services; Information Systems; Information Technology Systems; Institutes; Interview; Interviewer; Investigators; Knowledge; Language; Linguistic; Linguistics; Measures; Medicaid; Medical Specialities; Mental Health; Mental Health Services; Mental Hygiene; Mental Hygiene Services; Methods; Modeling; PROV; Persons; Phone; Policies; Population; Population Heterogeneity; Programs (PT); Programs [Publication Type]; Protocol Screening; Provider; Psychological Health; Public Health; Race; Racial Group; Report (document); Reporting; Research; Research Personnel; Research Resources; Researchers; Resources; Rural; Services; Source; Sources, Data; Specialties, Medical; Specialty; Specific qualifier value; Specified; Stocks, Racial; Sum; Surgeon; Survey Instrument; Surveys; System; System, LOINC Axis 4; Systems, Data; Telephone; Time; Training; Translating; Translatings; United States Agency for Health Care Policy and Research; United States Agency for Healthcare Research and Quality; United States Department of Health and Human Services; United States Dept. of Health and Human Services; Variant; Variation; Writing; access to services; access to treatment; adult human (21+); authority; availability of services; base; beneficiary; diverse populations; ethnic minority; ethnic minority population; experience; federal policy; health care availability; health care service access; health care service availability; health services availability; healthcare access availability; healthcare service access; healthcare service availability; help seeking; help-seeking behavior; heterogeneous population; improved; language translation; medical specialties; medically necessary; medically necessary care; meetings; programs; public health medicine (field); response
Project start date: 2006-01-01
Project end date: 2010-12-31
Budget start date: 1-JAN-2009
Budget end date: 31-DEC-2010
5R01MH070942-04 (2009): $268443