Abstract: Availability of Outpatient Rehabilitation Services and Barriers to Care for Vulnerable Populations after Pediatric Traumatic Brain Injury (Society for Social Work and Research 20th Annual Conference - Grand Challenges for Social Work: Setting a Research Agenda for the Future)

Schedule:

Saturday, January 16, 2016: 11:15 AM

Meeting Room Level-Meeting Room 12 (Renaissance Washington, DC Downtown Hotel)

* noted as presenting author

Megan Moore, PhD, Assistant Professor, University of Washington, Seattle, WA

Nathalia Jimenez, MD, Assistant Professor, University of Washington, Seattle, WA

Ali Rowhani-Rahbar, MD, MPH, Assistant Professor, University of Washington, Seattle, WA

Margaret Willis, MA, Doctoral Student, Boston College, Boston, MA

Kate Baron, Student, University of Washington, Seattle, WA

Jessica Giordano, MA, Brain Injury Alliance of Washington staff, Brain Injury Alliance of Washington, Seattle, WA

Deborah Crawley, Director, Brain Injury Alliance of Washington, Brain Injury Alliance of Washington, Seattle, WA

Frederick P. Rivara, MD, MPH, Professor, University of Washington, Seattle, WA

Kenneth M. Jaffe, Professor, University of Washington, Seattle, WA

Background and Purpose:Traumatic brain injury (TBI) is the leading cause of death and disability for children in the United States. Rehabilitation services can significantly improve functional outcomes after TBI and constitute the standard of care for treatment of physical, cognitive and behavioral impairments resulting in disability. Prior studies, mainly in adult populations, have described important racial and ethnic disparities in access to acute and inpatient rehabilitation services. The effect of insurance status and English proficiency on the availability and proximity of recommended pediatric outpatient rehabilitation services after TBI remains unknown. Aims were to explore associations between English proficiency, insurance status and outpatient rehabilitation service availability and travel time for children with TBI.

Methods: This study used an ecologic cross-sectional design. Data were analyzed from a cohort of 82 children (<18 years) treated for moderate to severe TBI and rehabilitation providers in Washington State. Main measures included availability and travel time to rehabilitation services. Descriptive statistics and maps were used to assess provider and service availability. Negative binomial regression models with robust standard errors were used to assess availability of multilingual services by county characteristics, and for each type of service we tested a linear regression model of travel time on parental language.

Results: Fewer than 20% of rehabilitation providers accepted children with Medicaid and provided language services. Mental health service provision was most limited. Adjusted for median household income, availability of multilingual services was lowest in counties with greater language diversity; for every 10% increase in persons over 5 years old speaking a language other than English at home, there was a 34% decrease in availability of multilingual pediatric services (Prevalence ratio = 0.66; 95%; CI: 0.48-0.90). Adjusted for education and Medicaid status, children from Spanish-speaking families with limited English proficiency had significantly longer travel times to all services: mean of 16 additional minutes to mental health and 9 additional minutes to other therapies.

Conclusions and Implications: Children in households with limited English proficiency and Medicaid insurance faced significant barriers in availability and proximity of outpatient rehabilitation services. There is a need for innovative research, policies and service strategies to equitably improve availability of services and functional outcomes for children with TBI.