Minority youth in foster care: managed care and access to mental health treatment.
BACKGROUND
Public sector mental health treatment has been transformed in recent years by the advent of managed care, but investigators of managed care policy have not yet focused on ethnic minority children, especially those involved with the child welfare system. Because of an overrepresentation of high-need minority children, foster care in particular is important to consider.


OBJECTIVE
The present study examined children placed in foster care and documented differences between minority children and youth (black persons, Hispanic persons, and white persons) in use of mental health services. The primary concern of the study was to consider whether there were differences in access to services or service use among the groups in the transition to capitated managed care.


METHODS
Medicaid claims and encounter data for two experimental managed care sites and one comparison fee-for-service site are used in a "difference-in-difference" analysis to estimate a changes in inpatient, outpatient, and residential treatment center (RTC) utilization, controlling for patient characteristics.


RESULTS
The study finds persistent declines in inpatient and outpatient use for all ethnic groups, persistent under-representation of Hispanic persons and black persons in treatment regardless of managed care, and greater use of RTCs by black persons and Hispanic persons that is attributable in part to managed care.


CONCLUSIONS
Black and Hispanic children received more rather than less mental health care under capitated managed care. The significance of this shift, largely increased in use of RTCs, however, cannot be determined at present, as the effectiveness of treatment delivered in RTCs is not known.
Snowden
Lonnie R
LR
School of Social Welfare, University of California Berkeley, Berkley, California 94720, USA. snowden@uclink4.berkeley.edu
Cuellar
Alison Evans
AE
Libby
Anne M
AM
D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003120:Colorado; D003627:Data Interpretation, Statistical; D005163:Factor Analysis, Statistical; D005260:Female; D005581:Foster Home Care / Q000191:economics / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000191:economics / Q000706:statistics & numerical data*; D008484:Medicaid / Q000191:economics / Q000706:statistics & numerical data*; D008605:Mental Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D015233:Models, Statistical; D012044:Regression Analysis; D012494:Sampling Studies; D044465:White People / Q000706:statistics & numerical data