Name: PowerPoint Presentation
Uploaded: 2022-05-01
Duration: 6 min 23 s
Description: DISPARITIES IN ACCESS TO DEVELOPMENTAL AND COUNSELING SERVICES IN CHILDREN FROM NON-ENGLISH-SPEAKING HOUSEHOLDS Pia Maalouf, MD Brown University.

DISPARITIES IN ACCESS TO DEVELOPMENTAL AND COUNSELING SERVICES IN CHILDREN FROM NON-ENGLISH-SPEAKING HOUSEHOLDS Pia Maalouf, MD Brown University. 

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DISPARITIES IN ACCESS TO DEVELOPMENTAL AND COUNSELING SERVICES IN CHILDREN FROM NON-ENGLISH-SPEAKING HOUSEHOLDS Pia Maalouf, MD Brown University

Limited  data is available about access to behavioral/developmental services or counseling for children from diverse ethnic/racial backgrounds. Important  disparities  exist in diagnosing and managing autism spectrum disorder (ASD) and other developmental disabilities in children from ethnic/racial minority backgrounds   Mixed results  have been found regarding the association of race/ethnicity/language and the access to counseling/treatment from a specialized mental health provider Most studies that investigated disparities in access to developmental services have focused on children with  ASD Some studies have shown that non-citizenship or low-income, and non-English primary language are  potential barriers  to the management of children with  ASD  especially among  Hispanic  families One study specifically found that  Hispanic  children with ASD were diagnosed almost one year later than white children, received fewer specialty services, and had higher unmet service needs One study showed that limited English proficiency may contribute to  mental   health   care  disparities in adults.

This study seeks to explore the association between: Exposure  Outcome #1 Outcome #2

Study sample: Data:  2018-2019 National Survey of Children’s Health (NSCH) Eligible population:  children, age 3-17  yo , with mental, emotional, developmental or behavioral problems.  n=13,053 (English-speaking 12,630  Non-English-speaking 423) Conditions included:  ASD, ADHD, Tourette Syndrome, Anxiety, depression, behavioral and conduct problem, developmental delay, intellectual disability, speech or other language disorder, and learning disability. Covariates: Potential confounders:  mental health status of mother, mental health status of father, physical health status of mother, physical health status of father, adverse childhood experiences and children living in “working poor” families. Analysis: We performed all analyses in STATA 17.

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Table 1 : Unadjusted and adjusted odds ratios of access to counseling or special services among children age 3-17yo with mental, emotional, developmental or behavioral problems, 2018-2019 NSCH

Characteristics  Unadjusted OR  for counseling services (95%CI)  Unadjusted OR for special services (95%CI) Adjusted OR for counseling services (95%CI) Adjusted OR for special services (95%CI) (Exposure)  English speaking household  Non-English speaking household   1.00(Ref)   0.63(95%CI)   1.00(Ref)   1.14(95%CI)   1.00 (Ref)   0.89(95%CI)   1.00 (Ref)   1.22 (95%CI) Mental health status of mother     Excellent/very good/good     Poor/fair        1.00(ref) 1.81(95% CI)        1.00 (Ref) 0.99(95%CI)       1.00(ref) 1.66 (95% CI)       1.00 (Ref) 0.99 (95%CI) Physical health status of mother    Excellent/very good/good    Poor/fair       1.00(ref) 1.35 (95% CI)       1.00 (Ref) 1.00(95%CI)       1.00(ref) 0.97 (95% CI)       1.00 (Ref) 1.04 (95%CI) Adverse childhood experiences    ACES   No ACES      1.66 (95%CI) 1.00(Ref)     0.9(95%CI) 1.00(Ref)     1.56 (95%CI) 1.00(Ref)     0.86 (95%CI) 1.00(Ref) Children living in “working poor” families    Live in 'working poor' household  Do not live in 'working poor' household       0.78 (95%CI)   1.00(Ref)       1.49(95%CI)   1.00(Ref)       0.67 (95%CI)   1.00(Ref)       1.53 (95%CI)   1.00(Ref)

Annie  Gjelsvik , PhD Pamela High, MS MD Yvette  Yatchmink , MD PhD

After adjusting for confounders, it seems that the association between the primary household language and access to services/counseling is  not significant .  Further studies and additional data collection required. Key limitations:  In the NSCH, Non-English-speaking households are less likely to participate (surveys are parent-completed online or via paper) In the NSCH, surveys are based on parent-report without medical record review.  Additional confounders need to be considered.  Future plans:  Turning this research into a QI project at the CNDC (Children's Neurodevelopment Center at Hasbro Children's Hospital)

Children in non-English households are 11% less likely to receive counseling services and 22% more likely to receive special services compared to children in English-speaking households.   Children with mothers who have fair/poor mental health status are 66% more likely to receive counseling services compared to children with mothers who have excellent/very good/good mental health status.  Children who have experienced ACEs are 56% more likely to receive counseling services and 14% less likely to receive special services compared to children who have not experienced ACEs.  Children living in working poor families are 33% less likely to receive counseling services and 53% more likely to receive special services compared to children not living in working poor families.

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