Why some U.S. kids don’t get brain injury rehab

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Language can be a barrier to treatment from Spanish-speaking children who’ve suffered a traumatic brain injury, according to a study of health care providers in Washington state.

The study found that less than 20 percent of rehabilitation providers in Washington accept Medicaid and also provide language interpretation to children with traumatic brain injuries. Just 8 percent provide mental health services to those children. Also, Spanish-speaking families have to travel significantly farther to access services.

“Language services need to be a routine part of health care services, not a standalone thing.”

The findings highlight how already disadvantaged children are further affected by limited access to the rehabilitation services that vastly improve long-term outcomes, says lead author Megan Moore, assistant professor in direct practice at the University of Washington School of Social Work and a core faculty member at the Harborview Injury Prevention and Research Center.

“Rehabilitation after a brain injury is incredibly important, especially for kids with moderate to severe brain injuries. Ultimately, that limited availability is going to impact children’s outcomes.”

For the study, published in the American Journal of Physical Medicine & Rehabilitation, researchers compiled a database of 293 health providers in Washington state that offer physical and occupational therapy; speech, language, and cognitive therapy; and mental health services. Each provider was called and asked about the types of services offered, whether Medicaid was accepted, and if interpretation was available for non-English-speaking families.

The findings highlight the extra hurdles these families encounter:

  • Only 46 percent of providers accept children with Medicaid.
  • Children covered by Medicaid have fewer rehabilitation services available than those covered by private insurance.
  • In each of the three general areas of health care listed above, there were fewer services for children whose families needed language interpretation.
  • While mental health services comprised more than half of the rehabilitation services available, only 8 percent of those providers accepted children with Medicaid who needed language services.
  • Less than half of the physical and occupational services accepted children with Medicaid and provided language services.
  • In total, less than 20 percent of all providers accepted children with Medicaid and also provided language services.

The researchers also looked at travel times for 82 children with moderate to severe traumatic brain injuries who were treated at Harborview Medical Center, using data from a previous study. regardless of their child’s insurance status, Spanish-speaking parents had to drive an average of 16 minutes more than English-speaking parents to reach a mental health provider, and they had to travel an additional nine minutes to get to physical, occupational, speech, and cognitive therapy.

‘It’s a huge problem’

More diverse counties also had fewer multilingual rehabilitation services—for every 10 percent increase in non-English speakers over the age of 5 at home, there was a 34 percent drop in the availability of those services.

The inequities may be even greater, researchers warn, since providers who accept Medicaid may routinely limit the number of Medicaid-covered children that they accept, due to lower reimbursement rates.

[Medicare advantage doesn’t measure up in Puerto Rico]

The study is a follow-up to earlier research which found disparities in outcomes among Latino children after traumatic brain injuries. The researchers wondered whether the disparities might have to do with a lack of rehabilitation services generally, but instead identified an access issue for low-income children from families with limited English proficiency.

That gap is particularly worrisome given the state’s increasing diversity—more than 18 percent of households spoke a language other than English in 2012 and almost half of children younger than 18 had Medicaid insurance in 2011.

Advocates regularly hear that families are being turned away from health care providers or being required to provide their own interpreters, says Joana Ramos, co-chair of the Washington State Coalition for Language Access.

“It’s a huge problem, and we definitely need to get everybody on board to address it, not just the advocates. Language services need to be a routine part of health care services, not a standalone thing.”

Since the bulk of rehabilitation after a brain injury takes place in the community, workers at the hospitals where children are initially treated should try to connect parents with services before they leave.

“We need to be thinking more critically about how we transition kids back to the community, particularly children we know have limited access to services,” she says. “We really have to do a thorough job of linking them to these services on the outpatient side. Knowing what we know now, it’s a social justice obligation.”

The National Center for Advancing Translational Sciences of the National Institutes of Health and the National Institute of Child Health and Human Development funded the work.

Other researchers from the University of Washington and from Boston College are coauthors of the study.

Source: University of Washington