Research Reports - Availability of outpatient rehabilitation services for children after traumatic brain injury: Differences by language and insurance status

Am J Phys Med Rehabil. 2015 Aug 7. [Epub ahead of print]

Moore M(1), Jimenez N, Rowhani-Rahbar A, Willis M, Baron K, Giordano J, Crawley
D, Rivara FP, Jaffe KM, Ebel BE.

OBJECTIVE: The objective of this study was to explore associations between
English proficiency, insurance status, outpatient rehabilitation service
availability, and travel time for children with traumatic brain injury.
DESIGN: The authors used an ecologic cross-sectional design. Data were analyzed
from a cohort of 82 children with moderate to severe traumatic brain injury and
rehabilitation providers in Washington State. Main measures included availability
and travel time to services.
RESULTS: Less than 20% of providers accepted children with Medicaid and provided
language interpretation. Mental health services were most limited. Adjusted for
median household income, multilingual service availability was lowest in counties
with greater language diversity; for every 10% increase in persons older than 5
yrs speaking a language other than English at home, there was a 34% decrease in
availability of multilingual services (prevalence ratio, 0.66; 95% confidence
interval, 0.48-0.90). Adjusted for education and Medicaid status, children from
Spanish-speaking families had significantly longer travel times to services
(mean, 16 additional minutes to mental health; 9 to other therapies).
CONCLUSIONS: Children in households with limited English proficiency and Medicaid
faced significant barriers in availability and proximity of outpatient
rehabilitation services. Innovative service strategies are needed to equitably
improve availability of rehabilitation for children with traumatic brain injury.
Similar studies in other regions will inform one's understanding of the scope of
these disparities. 

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