Racial disparities in mental health outcomes

The FAST$ database includes longitudinal data on the clinical outcomes of 4,987 youth and their families who received Medicaid-reimbursable behavioral health treatment in addition to the non-Medicaid reimbursable services made available through the FAST$ funding. As a subset of the state database on treatment services and outcomes for Medicaid eligible clients, the FAST$ database contains an array of important family variables (structure, mobility, stressors, processes) not found in the overall database. At the same time, additional information on local resource allocation (total dollars available for service delivery) throughout Ohio's 88 counties is available but has not been utilized by researchers to date. Given the substantial federal efforts to expand research on disparities related to mental health issues, greater utilization of these overlapping databases is warranted. Our long-term goal is to better understand disparities in service delivery and associated mental health outcomes. For the research we propose here, our objective is to first determine if there is a mediating effect of local resource allocation on the relationships between youths' racial background, service utilization, and clinically reliable treatment gains or losses. Next, we will examine the possible moderating effect of meeting family caregiver wants and needs on all these associations. The rationale underlying the proposed research is that a better understanding of the linkages between youth demographic and background characteristics on the one hand and their service utilization and mental health outcomes on the other will allow administrators to develop policies and procedures specifically designed to implement programs aimed at reducing the existing disparities.

 

Our study is innovative because it represents a unique opportunity to forge a partnership between the state of Ohio's Department of Mental Health (see letter of support from the ODMH director) and The Ohio State University (OSU) while taking advantage of these important state databases. Our team can begin to address questions such as: Do people of color have different outcomes depending on their geographic location? Do counties with fewer resources have higher levels of problem severity by the time their youth receive services? Do counties with higher resource allocation also have more hard to treat populations? Are youth who are receiving mental health services concentrated in economically disadvantaged/minority neighborhoods? Addressing such questions will open new arenas for pursuing and applying our research, including necessary next steps to include information on other client characteristics available in other state databases. Support for our hypotheses will have an important role to play in informing current efforts to evaluate the impact of financial systems now in place that have the potential to reduce disparities in both service delivery and clinical outcomes. Our analyses will also provide important preliminary findings necessary to submit a proposal for external funding.

 

Relation  of  the  proposed  work  to  previous  and  ongoing  work by the investigator (a) Stephen Gavazzi has undertaken evaluation of the FAST$ Project to date through a series of grants from ODMH. Through three years of existence, the FAST funding stream had touched the lives of almost 5,000 youth and families in Ohio. The longitudinal database generated though this evaluation effort is incredibly rich, and creates an exceptional opportunity to better understand the impact of behavioral health care issues on the lives of children, adolescents, and their families. The research team is uniquely poised to undertake such an effort, combining experience in assessment and intervention work that has targeted the families of at-risk youth (Gavazzi and Fristad), knowledge of spatial analysis methods and geographic information systems (GIS) (Kwan), familiarity with mental health policies surrounding the Medicaid program (Tanenbaum), and expertise in methodological and statistical approaches to large-scale databases (Cooksey and Snyder) .

 

An important outcome of this research will be the creation of information that can guide and direct empowerment efforts targeting families that contain children and adolescents with significant behavioral health needs. This study is innovative in a number of ways, including its focus on the specific nature of racial inequalities as a function of both resource allocation and family caregiver wants and needs. In addition, multiple disciplines are represented in an effort to generate ground-breaking information about behavioral health care treatment efforts targeting children and adolescents. Hence, an additional important outcome will involve the analysis of longitudinal data that can inform policies concerning the treatment services made available to children and adolescents covered by the Medicaid program.