Effects of Medicaid managed care policies on mental health service use among a national probability sample of children in the child welfare system

Children in the child welfare system are dependent upon Medicaid to finance services for their considerable mental health needs. This study examines the effects of Medicaid policies on mental health service use among a national probability sample of children in the child welfare system. Data for this study came from the National Survey of Child and Adolescent Well-Being, the Caring for Children in Child Welfare study, and the Area Resource File. Weighted multivariate logistic regression analyses were conducted to estimate effects of policy variables on children's use of mental health services, controlling for child-level covariates and county-level health resources. Children in counties with behavioral carve-outs under Medicaid managed care had lower odds of inpatient mental health service use. Medicaid managed care enrollment and variations in type of provider reimbursement did not affect use of mental health services. Older age, greater need for mental health services, and higher levels of caregiver education were associated with increased odds of service use. Restrictions on use of inpatient mental healthcare caused by behavioral carve-outs may disproportionately affect children in the child welfare system who have high rates of such use. Careful adoption of carve-outs is necessary to assure appropriate care for these children.     

International guidelines and the inclusion of disabled people. The Ugandan story

Uganda has made much progress towards including disabled people in its mainstream development, particularly in the political agenda. The exact process by which this has been achieved and the relationship between this and international guidelines and legislation are not known. This study undertakes to examine this from two specific perspectives: (1) How do international documents relevant to disabled people relate to national legislation in Uganda? (2) What can this comparison, together with the perceptions of stakeholders, tell us about how the legislation and services could improve? International legislation and Ugandan legislation is reviewed and compared. Data from 5 semi‐structured key informant interviews and 6 focus group discussions involving a total of 38 people are collected and analysed. The themes arising from the data are related to the documents, legislation, policies and other relevant literature. The results examine the barriers to service provision; the role of change; the importance of representation; policy and legislation issues; and the effects of devolution. Five specific findings relate to how legislation and services can improve: more resources to increase access for disabled people; strong leadership and collaboration between Disabled People’s Organisations (DPOs) funding bodies and governments; awareness raising and training; representation from all impairment groups; and raising the profile of disabled people through further legislation.     

MODEL-ASSISTED HIGHER-ORDER CALIBRATION OF ESTIMATORS OF VARIANCE

In survey sampling, interest often centres on inference for the population total using information about an auxiliary variable. The variance of the estimator used plays a key role in such inference. This study develops a new set of higher‐order constraints for the calibration of estimators of variance for various estimators of the population total. The proposed strategy requires an appropriate model for describing the relationship between the response and auxiliary variable, and the variance of the auxiliary variable. It is therefore referred to as a model‐assisted approach. Several new estimators of variance, including the higher‐order calibration estimators of the variance of the ratio and regression estimators suggested by Singh, Horn & Yu and Sitter & Wu are special cases of the proposed technique. The paper presents and discusses the results of an empirical study to compare the performance of the proposed estimators and existing counterparts.     

Population constraints on pooled surveys in demographic hazard modeling

In non-experimental research, data on the same population process may be collected simultaneously by more than one instrument. For example, in the present application, two sample surveys and a population birth registration system all collect observations on first births by age and year, while the two surveys additionally collect information on women’s education. To make maximum use of the three data sources, the survey data are pooled and the population data introduced as constraints in a logistic regression equation. Reductions in standard errors about the age and birth-cohort parameters of the regression equation in the order of three-quarters are obtained by introducing the population data as constraints. A halving of the standard errors about the education parameters is achieved by pooling observations from the larger survey dataset with those from the smaller survey. The percentage reduction in the standard errors through imposing population constraints is independent of the total survey sample size.     

Banks winners in tournaments are difficult to recognize

Given a tournament T, a Banks winner of T is the top vertex of any maximal (with respect to inclusion) transitive subtournament of T. In this technical note, we show that the problem of deciding whether some fixed vertex v is a Banks winner for T is NP-complete. Received: 22 February 2002/Accepted: 20 June 2002 Supported by the START program Y43-MAT of the Austrian Ministry of Science. I would like to thank two thank the referees for a careful reading of the paper, for helpful remarks, and for many suggestions how to improve the presentation.