Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose: To examine racial/ethnic disparities in psychiatric crisis service use among African American and Caucasian children, and to determine if differences in utilization of crisis services are moderated by receipt of outpatient linkage services prior to or following the crisis. Method: We conducted a retrospective analysis of more than 15,000 California Medicaid records from 1998-2001 for Medicaid-eligible children under age 18. Linkage services were defined as referral and case management services billed under the “linkage/brokerage” category in the Medicaid records. Logistic regression was used to estimate the probability of initial crisis use, controlling for receipt of prior outpatient linkage services three months before the crisis, and the probability of a second crisis visit controlling for receipt of outpatient linkage services three months after the first crisis. Linear regressions were used to estimate the intensity of service use. A fixed effects model controlled for county, year and client characteristics. Results: African American children were significantly more likely than Caucasian children to use both types of crisis services and they had significantly more crisis visits than Caucasian children. Additionally, African Americans were significantly less likely to receive outpatient linkage services in the 3 months prior to or after their first crisis visit. African Americans who did not receive aftercare services had rates of second crisis visits that were similar to Caucasians. However, African Americans who did receive aftercare services were significantly less likely than Caucasians to have a second crisis visit. Implications: Racial ethnic disparities in receipt of outpatient linkage services may lead to disparities in crisis care use. African American children who do not receive outpatient linkage services may be forced to rely on crisis services as their gateway into mental health treatment. Mental Health practitioners should be aware of this disparity, and promote equal access to outpatient services.