Linked Child Welfare and Medicaid Data in Kentucky and Florida Highlights Racial Disparities in Access to Care

Abstract

Parents with serious mental health (MH) and substance use disorders (SUD) can face profound challenges caring for their children. MH/SUD treatment can improve outcomes for both parents and their children. This study evaluated whether parents with Medicaid with MH/SUD conditions whose children had child protective services (CPS) involvement were receiving MH/SUD treatment and whether receipt differed by race. We analyzed the 2020 Child and Caregiver Outcomes Using Linked Data (CCOULD) which contains Medicaid and child welfare records from Kentucky and Florida on 58,551 CPS-involved caregivers. Among caregivers with an MH diagnosis, White individuals were more likely than Black individuals to have received counseling (42% vs. 20%) or an MH medication (69% vs. 52%). Among caregivers with an SUD, White individuals were more likely than Black individuals to have received counseling (43% vs. 20%) or an SUD medication (43% vs. 11%). More effort is needed to connect parents with CPS involvement to MH/SUD treatment, particularly Black parents.

Keywords

mental health substance use disorders child welfare racial disparities family preservation

Get full access to this article

View all access options for this article.

References

Administration for Children and Families (ACF), and Centers for Medicare and Medicaid Services (CMS) . (2022). Toolkit: Data sharing for child welfare agencies and Medicaid. U.S. Department of Health and Human Services. https://www.acf.hhs.gov/sites/default/files/documents/cb/data-sharing-and-medicaid-toolkit.pdf

Aggarwal

N. K.

Pieh

M. C.

Dixon

Guarnaccia

Alegría

Lewis-Fernández

(2016). Clinician descriptions of communication strategies to improve treatment engagement by racial/ethnic minorities in mental health services: A systematic review. Patient Education and Counseling, 99(2), 198–209. https://doi.org/10.1016/j.pec.2015.09.002

Anderson

L. M.

Adeney

K. L.

Shinn

Safranek

Buckner-Brown

Krause

L. K.

(2015). Community coalition-driven interventions to reduce health disparities among racial and ethnic minority populations. Cochrane Database of Systematic Reviews, 2015(6), CD009905. https://doi.org/10.1002/14651858.CD009905.pub2

Centers for Disease Control and Prevention . (2022). Child abuse and neglect: Risk and protective factors. Centers for Disease Control and Prevention. https://www.cdc.gov/violenceprevention/childabuseandneglect/index.html (Accessed 1 November 2023).

Centers for Medicare and Medicaid Services . (2023). DQ atlas. https://www.medicaid.gov/dq-atlas/welcome Accessed 24 June 2023.

Children’s Bureau . (2023). Child maltreatment 2021. Administration on children, youth and families, administration for children and families. U.S. Department of Health and Human Services. https://www.acf.hhs.gov/sites/default/files/documents/cb/cm2021.pdf

Choi

Rosenbloom

Stein

M. D.

Raifman

Clark

J. A.

(2022). Differential gateways, facilitators, and barriers to substance use disorder treatment for pregnant women and mothers: A scoping systematic review. Journal of Addiction Medicine, 16(3), Article e185–e196. https://doi.org/10.1097/ADM.0000000000000909

Doab

Fowler

Dawson

(2015). Factors that influence mother-child reunification for mothers with a history of substance use: A systematic review of the evidence to inform policy and practice in Australia. International Journal of Drug Policy, 26(9), 820–831. https://doi.org/10.1016/j.drugpo.2015.05.025

Family First Prevention Services Act of 2017 . (2017). https://www.congress.gov/bill/115th-congress/house-bill/253/text

10.

Ghertner

Waters

Radel

Crouse

(2018). The role of substance use in child welfare caseloads. Children and Youth Services Review, 90, 83–93. https://doi.org/10.1016/j.childyouth.2018.05.015

11.

Kaiser Family Foundation . (2023). Medicaid state fact sheets. https://www.kff.org/interactive/medicaid-state-fact-sheets/

12.

Kim

Wildeman

Jonson-Reid

Drake

(2017). Lifetime prevalence of investigating child maltreatment among US children. American Journal of Public Health, 107(2), 274–280. https://doi.org/10.2105/AJPH.2016.303545

13.

Klaman

S. L.

Isaacs

Leopold

Perpich

Hayashi

Vender

Campopiano

Jones

H. E.

(2017). Treating women who are pregnant and parenting for opioid use disorder and the concurrent care of their infants and children: Literature review to support national guidance. Journal of Addiction Medicine, 11(3), 178–190. https://doi.org/10.1097/ADM.0000000000000308

14.

Mark

T. L.

Dolan

Allaire

Bradley

(2022). Linking child welfare and Medicaid data: Lessons learned from two states [OPRE Report 2023-038]. In Office of planning, research, and evaluation, administration for children and families, office of the assistant secretary for planning and evaluation. U.S. Department of Health and Human Services.

15.

Mark

T. L.

Goode

S. A.

McMurtrie

Weinstein

Perry

R. J.

(2023). Improving research on racial disparities in access to medications to treat opioid use disorders. Journal of Addiction Medicine, 17(3), 249–257. https://doi.org/10.1097/ADM.0000000000001104

16.

Medicaid and CHIP Payment and Access Commission (MACPAC) . (2015). The intersection of Medicaid and child welfare. In Report to congress on Medicaid and CHIP (pp. 57–86). https://www.macpac.gov/wp-content/uploads/2015/06/June-2015-Report-to-Congress-on-Medicaid-and-CHIP.pdf

17.

Mykyta

Keisler-Starkey

Bunch

(2022). More children were covered by Medicaid and CHIP in 2021. U.S. Census Bureau. https://www.census.gov/library/stories/2022/09/uninsured-rate-of-children-declines.html

18.

Quast

Storch

E. A.

Yampolskaya

(2018). Opioid prescription rates and child removals: Evidence from Florida. Health Affairs, 37(1), 134–139. https://doi.org/10.1377/hlthaff.2017.1023

19.

Raz

Dettlaff

Edwards

(2021). The perils of child “protection” for children of color: Lessons from history. Pediatrics, 148(1), Article e2021050237. https://doi.org/10.1542/peds.2021-050237

20.

SCAN Policies Database . (2021). SCAN policies database state profile 2021: Kentucky. Mathematica. https://www.scanpoliciesdatabase.com/sites/default/files/2023-04/SCAN-Policies-Database-Kentucky-Profile.pdf

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.22 MB