Disparities in receipt of specialty services among children with mental health need enrolled in the CMHI.

Abstract

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). 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. 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. 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.