This summary synthesizes findings from a single research study, Linked Child Welfare and Medicaid Data in Kentucky and Florida Highlights Racial Disparities in Access to Care.
What can we learn from this study?
Parents experiencing co-morbidities of severe mental health and substance use disorders can face significant challenges when caring for their children, which can increase the likelihood of involvement with child protective services (CPS). This study examines whether differences exist in access to Medicaid-funded treatments for these disorders among child welfare-involved caregivers. The data set used is the first known to link Medicaid records to caregivers identified by CPS, offering a unique opportunity to examine potential racial disparities within this population.
Study details
- Population: 58,551 CPS-involved caregivers in Kentucky and Florida
- Data sources: 2020 Child and Caregiver Outcomes Using Linked Data (CCOULD) Medicaid claims files
- Methodologies: Two-sample t test for proportions; Bonferroni adjustment for correcting for multiple comparisons
- Dates: January 2017 to January 2020 (Kentucky); January 2017 to June 2021 (Florida)
Citation: Mark, T. L., Dolan, M., Allaire, B., Parish, W., Poehler, D., Strack, C., Madden, E., & Butler, V. (2024). Linked child welfare and Medicaid data in Kentucky and Florida highlights racial disparities in access to care. Child Maltreatment, 30(1), 3-8. HTTPS://DOI.ORG/10.1177/10775595241234569
What are the critical findings?
- When compared to white CPS-involved caregivers with a mental health diagnosis, Black CPS-involved caregivers with a mental health diagnosis were significantly less likely to receive counseling (20% vs. 42%) or medications to treat their condition (52% vs. 69%).
- Black caregivers with substance use disorders were less likely to receive any counseling or medications to treat their condition:
- 20% of Black caregivers received substance use disorder counseling compared to 43% of white caregivers.
- 11% of Black caregivers received medications to treat substance use disorder compared to 43% of white caregivers.
- When compared to white CPS-involved caregivers with an opioid use disorder, Black caregivers were significantly less likely to receive counseling (20% vs. 46%) or medications (18% vs. 56%).
- Among CPS-involved Black caregivers, an unmet need exists for mental health and substance use disorder counseling and medications.
Why is this important for our work?
Mental health and substance use disorders are risk factors for child maltreatment and subsequent CPS removal of children from their families. Data show that Black children are disproportionately represented in foster care and less likely to be successfully reunified with their families, leading to longer episodes of family separation. This study highlights opportunities to address gaps in support for families involved in the child welfare system that are struggling with mental health or substance use challenges. Increasing equitable access to and use of early interventions for all caregivers dealing with these conditions can strengthen families and help keep children safe.
Casey Family Programs consults with individuals and teams across the country to compile research, experiences, and insights about approaches that can safely reduce the need for foster care and ensure the well-being of children and families. We share this information broadly to help child welfare leaders and their partners tackle similar issues in their own communities. For questions about this resource, or if you have other child welfare information needs, please email kmresources@casey.org.
