Asthma-Related Emergency Department Visits Among Low-Income Families With Young Children by Race/Ethnicity and Primary Language.

OBJECTIVE: The aim of this study was to examine the existence of racial/ethnic and language disparities in asthma-related emergency department (ED) initial and return visits among young children in low-income families in California. METHODS: Children younger than 6 years with at least 1 asthma-related ED visit recorded in the California Office of Statewide Health Planning and Development data set between January 1, 2009, and December 31, 2013, and on Medicaid (Medi-Cal) were assessed. Primary outcomes were hospitalization at the first asthma-related ED visit and a return asthma-related ED visit within 12 months. Data were analyzed using multivariate logistic regression. RESULTS: Among 47,657 children, approximately 55% were Hispanic, 20% were black, and 2.7% were Asian/Pacific Islander. For non-English-speaking families, 82% were Hispanic. Among English-speaking families, blacks were less likely to be hospitalized at the first ED visit (odds ratio [OR], 0.787; 95% confidence interval [CI], 0.715-0.866) but more likely to return to the ED (OR, 1.291; 95% CI, 1.205-1.383) compared with whites. Conversely, Asian/Pacific Islanders whose primary language was English were more likely to be hospitalized (OR, 2.150; 95% CI, 1.827-2.530) compared with whites. Among families whose primary language was not English, Hispanic and Asian/Pacific Islanders are more likely to be hospitalized at the first ED visit and all groups are less likely to return to the ED compared with English-speaking whites. CONCLUSIONS: The findings suggest that racial/ethnic and language disparities exist in eventual asthma-related hospitalizations and repeat ED visits. Continued research is needed to understand the existence of these differences and to inform future comprehensive and linguistically appropriate asthma interventions for children in low-income families.

The Relationship Between Linkages to Behavioral Health Services in Pediatric Primary Care and Reductions in Non-urgent Emergency Department Visits Among Vulnerable Children.

The integration of behavioral health (BH) services within pediatric primary care has been utilized as a way to address young children's social-emotional needs. This study aimed to examine whether linking at-risk young children to BH services is associated with a reduction in "non-urgent" emergency department (ED) visits. BH teams integrated in a pediatric clinic conducted socio-emotional screening in children 6-65 months of age and tracked ED utilization for children with positive screening. The results indicated that children with positive screening are less likely to have a non-urgent ED visit than children with negative screening with concerns (NWC) and are more likely to be connected to services. Among children in the NWC group, those connected to services were less likely to have non-urgent ED visits than those not connected to services. These findings suggest that integrated behavioral health care has the potential to reduce non-urgent ED visits among at-risk children.

The Prevalence of Mental Illness and Substance Abuse Among Rural Latino Adults with Multiple Adverse Childhood Experiences in California.

Adverse childhood experiences (ACEs) have been found to increase health and mental health risks in adulthood. Previous ACE studies tend to have small samples of Latinos; however, as Latinos are projected to be the largest minority group in the United States, it is important to examine how ACEs are associated with self-reported mental distress and alcohol and/or substance abuse among Latino populations. An ACEs survey was conducted in a predominantly Latino town; the sample included 195 individuals (18 or older), and the majority (92%) identified as Latino. Logistic regression showed that respondents with three or more ACEs, compared to those with no ACEs, were three times more likely to report more days of mental distress and eight times more likely to have alcohol and/or substance abuse problems. Further studies are needed to understand the association between ACEs and behavioral health using culturally and linguistically competent mental health screening tools.

Correction to: The Prevalence of Mental Illness and Substance Abuse Among Rural Latino Adults with Multiple Adverse Childhood Experiences in California.

The original version of this article unfortunately published without acknowledgement section. The complete funding information is given below.

Association between emergency department utilization and the risk of child maltreatment in young children.

BACKGROUND: This study aims to assess the association between emergency department (ED) utilization and the risk of child maltreatment. METHODS: Using ED discharge data from the California's Office of Statewide Health Planning (OSHPD) and Development for 2008-2013, we performed a nested case-control study to examine the relationship between the frequency of ED visits and child maltreatment diagnosis under 4 years of age among children born in California between 2008 and 2009 who visited the ED. RESULTS: The study sample consisted of 3772 children diagnosed with child maltreatment (cases) and 7544 children selected by incidence density sampling (controls). After adjustment for demographic characteristics, the estimated odds ratios of child maltreatment were 1.72 (95% CI:1.55-1.90) for those with two to three ED visits and 3.03 (95% CI: 2.69-3.41) for those with four or more ED visits, compared to children with one visit. Race/ethnicity, insurance status, and location of residence were also significantly associated with the risk of child maltreatment. CONCLUSIONS: Young children with higher frequency of ED visits are at significantly increased risk of being victims of child maltreatment. ED utilization patterns and other established risk markers may assist healthcare professionals in identifying and treating victims of child maltreatment.

Dual Food and Energy Hardship and Associated Child Behavior Problems.

OBJECTIVE: To examine dual food and energy hardship and internalizing and externalizing behavior problems in 9-year-old children. METHODS: We conducted a cross-sectional analysis of the Fragile Families and Child Wellbeing Study, a prospective national urban birth cohort, when the children were 9 years old. Maternal-reported "food hardship" (ever hungry and/or ever received free food) and "energy hardship" (ever unable to pay utility bill and/or utility shutoff) within the past year, and child behavior using the Child Behavior Checklist for Ages 6-18 were assessed. Multiple logistic regression analyses estimated associations between individual and dual food and energy hardship and child behavior problems, adjusting for a priori covariates (ie, child sex, health insurance, maternal sociodemographic characteristics, poverty, reported health, attention deficit hyperactivity disorder, depressive symptoms, smoking, and substance and alcohol abuse). RESULTS: Approximately 10% of households reported dual food and energy hardship. Children experiencing dual food and energy hardship had 3 times greater odds of withdrawn/depressed behaviors (adjusted odds ratio [AOR], 2.8; 95% confidence interval [CI], 1.4-5.5), threefold greater odds of somatic complaints (AOR, 3.2; 95% CI, 1.5-6.9), and 4 times greater odds of rule-breaking behavior (AOR, 3.7; 95% CI, 1.5-9.2) in the borderline/clinical range than children with no hardship, and had fourfold greater odds of borderline/clinical range somatic complaints (AOR, 4.2; 95% CI, 1.7-10.3) than children with only energy hardship. CONCLUSIONS: Children experiencing dual food and energy hardship have greater odds of coexisting internalizing and externalizing behaviors after controlling for possible confounders. Providers can consider screening and resource referrals for these addressable hardships alongside behavior assessments in the clinical setting.

Housing hardship and energy insecurity among native-born and immigrant low-income families with children in the United States.

The costs for rent and utilities account for the largest share of living expenses, yet these two critical dimensions of material hardship have seldom been examined concurrently in population-based studies. This paper employs multivariate statistical analysis using American Community Survey data to demonstrate the relative risk ratio of low-income renter-occupied households with children experiencing "rent burden," "energy insecurity," or a "double burden" as opposed to no burden. Findings suggest that low-income households are more likely to experience these economic hardships in general but that specific groups are disproportionately burdened in different ways. For instance, whereas immigrants are more likely to experience rental burden, they are less likely to experience energy insecurity and are also spared from the double burden. In contrast, native-born African Americans are more likely than all other groups to experience the double burden. These results may be driven by the housing stock available to certain groups due to racial residential segregation, decisions regarding the quality of housing low-income householders are able to afford, as well as home-country values, such as modest living and energy conservation practices, among immigrant families. This paper also points to important policy gaps in safety net benefits related to housing and energy targeting low-income households.

English Proficiency, Threshold Language Policy and Mental Health Service Utilization among Asian-American Children.

This paper explores the role of English proficiency, ethnicity, and California's threshold language policy in the rates of discontinuing mental health services among Asian-American children. We used data from the 2001-2006 Client and Services Information (CSI) System, which contains county-level information about service users in public mental health systems. Our data included 59,218 service users under the age of 18. We used logistic regression to determine the likelihood of discontinuing services, while controlling for sociodemographic and clinical characteristics. English-speaking Asians were 11% more likely than English-speaking Whites to discontinue mental health services. Non-English-speaking Asians were 50% significantly more likely to stay in services. The results also revealed some inter-ethnic variations in the discontinuation patterns; however, the patterns of mental health service utilization appear to be driven by the availability of mental health services in Asian-ethnic languages in county of residence. Further research is needed to understand the intake and referral processes that Asian children go through within the mental health service system.

The Effects of Runaway-Homeless Episodes on High School Dropout.

This article uses data from the National Longitudinal Survey of Youth 1997 to examine the relationship between running away from home between the ages of 12 and 14 and dropping from high school among youth. Propensity score matching was conducted in estimating the effect of running away on high school dropout while controlling for confounding factors, such as familial instability and socioemotional health risks. The findings suggest that having runaway-homeless episodes have a detrimental effect on academic achievement.

Children's mental health policies in the United States: perspectives from advocates and state leaders.

BACKGROUND: Previous research suggests a disconnect on both policy and practice between advocates and state leaders in child mental health. AIM: To compare advocates' and state leader's perspectives and understanding on the three main themes in children's mental health policies: (i) state's initiatives to empower and engage families and youth in policy and practice; (ii) state's fiscal support for family and youth driven services; and (iii) policy challenges to improving children's mental health services and outcomes. STUDY DESIGN: This study draws on data from national surveys of State Children's Mental Health Directors (2006) and of state affiliates of Mental Health America (2007). RESULTS: The findings from 38 responses representing 19 states suggest differences between state leaders and advocates on their understanding of family and youth engagement, service access, quality and fiscal supports. While state directors and advocates seem to have similar understanding on the existence of states' efforts related to evidence-based practices, many advocates are unaware of the specifics of the strategies that states undertook or funded. Advocates also did not know which types of settings were eligible for reimbursement for children's services. CONCLUSIONS: Advocates lack some information that is vital to fulfilling their role. Policymakers seem unaware of key challenges that families face and therefore appear to be without critical information that fuels the agenda for advocates. The challenge for both set of actors is how to get beyond this information asymmetry to advance efforts to improve mental health.

Disparities in repeat visits to emergency departments among transition-age youths with mental health needs.

OBJECTIVE: The purpose of this study was to examine racial-ethnic and gender differences in return visits to emergency services among transition-age youths (aged 17 to 24 years) with mental health needs. METHODS: Data were from the California Emergency Department and Ambulatory Surgery Data. Logistic regression was used to examine the odds of returning to an emergency department among youths who had a psychiatric diagnosis (N533,588). RESULTS: About 41% of the sample returned to the emergency department within a year. Compared with white males, the odds of returning were lower for Hispanic males (odds ratio [OR]5.89) and Asian males (OR5.59) and higher for white females (OR51.21), African- American females (OR51.49), Hispanic females (OR51.24), and Native American females (OR52.09). CONCLUSIONS: Repeat visits to emergency departments among transition age youths with psychiatric diagnoses may indicate limited access to or lack of high-quality care. The disparities indicate a need for culturally sensitive and gender-specific services for this vulnerable population.

Racial and ethnic disparities in the continuation of community-based children's mental health services.

This paper examines racial and ethnic disparities in continuation of mental health services for children and youth in California and how English language proficiency moderates the effect of race/ethnicity on the continuation of service. While previous research indicated racial/ethnic or geographic disparities in accessing mental health services among children and youth, few studies specifically focused on the continuation of mental health care. The authors used administrative data from California county mental health services users under age 25. Applying logistic regression, English language proficiency was found to be the major determinant of continuation of mental health services in this age group. With the exception of children of Asian descent, non-English speaking children and youth of diverse racial/ethnic background were significantly less likely to continue receiving mental health services compared with White English-speaking peers, even after controlling for sociodemographic, clinical and county characteristics.

The economic impact of adolescent health promotion policies and programs.

Adolescence is a critical period in the human lifecycle, a time of rapid physical and socioemotional growth and a time when individuals establish lifestyle habits and health behaviors that often endure into and have lasting effects in adulthood. Adolescent health promotion programs play a critical role in helping youth establish healthy lifestyles. In this article, we present a socio-ecological model as a framework for identifying effective policy and program areas that have a positive impact on adolescent health behaviors. Our discussion focuses on 4 key areas: reproductive health; obesity prevention; mental health and substance use, including smoking; and injury and violence prevention. We proceed with an overview of the current status of state-led adolescent health promotion policies and programs from a newly created policy database and then examine the evidence on the cost of preventable adolescent health problems and the cost-effectiveness of health promotion programs and policies. We conclude by discussing the threat posed to adolescent health promotion services and state-led policy initiatives by proposed and implemented federal and state-level budget cuts and examine the possible health and economic repercussions of reducing or eliminating these programs.

The status of states' policies to support evidence-based practices in children's mental health.

OBJECTIVE: This study examined the efforts of states' mental health authorities to promote the use of evidence-based practices through policy. METHODS: Data were drawn from three components of a national study, including a survey of state children's mental health directors (N=53), which was developed using a three-step process that involved stakeholders. RESULTS: Data from the directors' survey revealed that over 90% of states are implementing strategies to support the use of evidence-based practices. The scope of these efforts varies, with 36% reporting statewide reach. Further, states' strategies for implementing evidence-based practices are often not accompanied by comparable efforts to enhance information systems, even though enhancing such systems can bolster opportunities for successful implementation. CONCLUSIONS: Variability in the adoption of evidence-based practices, poor attention to information systems, and inconsistent fiscal policies threaten states' efforts to improve the quality of children's mental health services.