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Availability of Outpatient Rehabilitation Services for Children After Traumatic Brain Injury

Differences by Language and Insurance Status

Moore, Megan, PhD, MSW; Jimenez, Nathalia, MD, MPH; Rowhani-Rahbar, Ali, MD, MPH, PhD; Willis, Margaret, MA; Baron, Kate; Giordano, Jessica, MA; Crawley, Deborah, BA; Rivara, Frederick P., MD, MPH; Jaffe, Kenneth M., MD; Ebel, Beth E., MD, MSc, MPH

American Journal of Physical Medicine & Rehabilitation: March 2016 - Volume 95 - Issue 3 - p 204–213
doi: 10.1097/PHM.0000000000000362
Original Research Article

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.

From the Harborview Injury Prevention and Research Center (MM, NJ, AR-R, KB, FPR, KMJ, BEE), School of Social Work (MM), Departments of Anesthesiology and Pain Medicine (NJ), Pediatrics (FPR, KMJ, BEE), Epidemiology (AR-R, BEE), Rehabilitation Medicine (KMJ), and Neurological Surgery (KMJ), University of Washington, Seattle, Washington; Department of Sociology, Boston College, Chestnut Hill, Massachusetts (MW); and Brain Injury Alliance of Washington, Seattle, Washington (JG, DC).

All correspondence and requests for reprints should be addressed to: Megan Moore, PhD, MSW, School of Social Work, University of Washington, 4101 15th Ave NE, Box 354900, Seattle, WA 98195-4900.

Supported by the National Center for Advancing Translational Sciences of the National Institutes of Health (KL2TR000421 [MM]) and the National Institute of Child Health and Human Development (1K23HD078453-01 [NJ]). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

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