title: Availability of Outpatient Rehabilitation Services for Children After Traumatic Brain Injury: Differences by Language and Insurance Status.
abstract: OBJECTIVE
  The objective of this study was to explore associations between English proficiency, insurance status, outpatient rehabilitation service availability, and travel time for children with traumatic brain injury.
  
  
  METHODS
  The authors used an ecologic cross-sectional design. Data were analyzed from a cohort of 82 children with moderate to severe traumatic brain injury and rehabilitation providers in Washington State. Main measures included availability and travel time to services.
  
  
  RESULTS
  Less than 20% of providers accepted children with Medicaid and provided language interpretation. Mental health services were most limited. Adjusted for median household income, multilingual service availability was lowest in counties with greater language diversity; for every 10% increase in persons older than 5 yrs speaking a language other than English at home, there was a 34% decrease in availability of multilingual services (prevalence ratio, 0.66; 95% confidence interval, 0.48-0.90). Adjusted for education and Medicaid status, children from Spanish-speaking families had significantly longer travel times to services (mean, 16 additional minutes to mental health; 9 to other therapies).
  
  
  CONCLUSIONS
  Children in households with limited English proficiency and Medicaid faced significant barriers in availability and proximity of outpatient rehabilitation services. Innovative service strategies are needed to equitably improve availability of rehabilitation for children with traumatic brain injury. Similar studies in other regions will inform one's understanding of the scope of these disparities.
authors.affiliation: From the Harborview Injury Prevention and Research Center (MM, NJ, AR-R, KB, FPR, KMJ, BEE), School of Social Work (MM), Departments of Anesthesiology and Pain Medicine (NJ), Pediatrics (FPR, KMJ, BEE), Epidemiology (AR-R, BEE), Rehabilitation Medicine (KMJ), and Neurological Surgery (KMJ), University of Washington, Seattle, Washington; Department of Sociology, Boston College, Chestnut Hill, Massachusetts (MW); and Brain Injury Alliance of Washington, Seattle, Washington (JG, DC).
authors.forename: Megan
authors.initials: M
authors.lastname: Moore
authors.forename: Nathalia
authors.initials: N
authors.lastname: Jimenez
authors.forename: Ali
authors.initials: A
authors.lastname: Rowhani-Rahbar
authors.forename: Margaret
authors.initials: M
authors.lastname: Willis
authors.forename: Kate
authors.initials: K
authors.lastname: Baron
authors.forename: Jessica
authors.initials: J
authors.lastname: Giordano
authors.forename: Deborah
authors.initials: D
authors.lastname: Crawley
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Rivara
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Jaffe
authors.forename: Beth E
authors.initials: BE
authors.lastname: Ebel
mesh_terms: D000553:Ambulatory Care; D001930:Brain Injuries / Q000534:rehabilitation*; D002648:Child; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D006297:Health Services Accessibility; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D007802:Language; D007808:Language Therapy; D008484:Medicaid; D008605:Mental Health Services; D026741:Physical Therapy Modalities; D012959:Socioeconomic Factors; D013070:Speech Therapy; D014481:United States; D014861:Washington