Disparities in receipt of specialty services among children with mental health need enrolled in the CMHI.
OBJECTIVE
The study assessed racial-ethnic differences in receipt of mental health services among children enrolled in systems of care under the Children's Mental Health Initiative (CMHI).


METHODS
Survey data for 3,920 CMHI enrollees were used to estimate the association between race-ethnicity and the number of days in the 12 months postenrollment during which the child received individual psychotherapy, family and group psychotherapy, medication monitoring, assessment and evaluation, case management, residential treatment, and inpatient care. Two-part regressions with fixed site effects were estimated to adjust for geography and baseline population differences, including child and caregiver characteristics.


RESULTS
Compared with white non-Latino children, African Americans had lower odds of using any individual psychotherapy (odds ratio [OR]=.73, p=.019), family and group psychotherapy (OR=.79, p=.043), and medication monitoring (OR=.51, p<.001); among users of each service, African Americans had lower utilization of individual psychotherapy (incidence rate ratio [IRR]=.79, p<.001), family and group psychotherapy (IRR=.86, p=.011), and inpatient care (IRR=.75, p=.026). Latino children had lower odds of receiving medication monitoring (OR=.70, p=.007) and assessment and evaluation services (OR=.75, p=.027); among users, Latinos had lower utilization of individual (IRR=.91, p=.044) and family and group (IRR=.88, p=.044) psychotherapy. Pacific Islanders who received medication monitoring used services at a lower rate (IRR=.60, p=.009) than white children. No other associations with race-ethnicity were significant.


CONCLUSIONS
Racial-ethnic disparities in children's mental health treatment persist within systems of care. Further work is necessary to understand the role of individual program components, their interactions with community characteristics, and how they might affect mental health services use.
Dr. Popescu, Dr. Xu, and Dr. Ettner are with the Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles (e-mail: ipopescu@mednet.ucla.edu ). Ms. Krivelyova is with ICF Macro, Atlanta.
Ioana
I
Popescu
Haiyong
H
Xu
Anna
A
Krivelyova
Susan L
SL
Ettner
D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D002675:Child, Preschool; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D044469:Racial Groups / Q000706:statistics & numerical data; D012959:Socioeconomic Factors