Scope-of-Practice Expansions Associated with Reduced Racial Disparities in Pediatric Mental Health Care

• Published in: Community mental health journal 2024-11, Vol.60 (8), p.1579-1588
• Main Authors: Hughes, Phillip M., Graaf, Genevive, Gigli, Kristin H., deJong, Neal A., McGrath, Robert E., Thomas, Kathleen C.
• Format: Article
• Language: English
• Subjects: Adolescent; Black people; Child; Child, Preschool; Children; Clinical outcomes; Community and Environmental Psychology; Drugs; Ethnicity; Female; Health care access; Health disparities; Health Services Accessibility - statistics & numerical data; Healthcare Disparities - ethnology; Humans; Inequality; Interaction terms; Male; Medicine; Medicine & Public Health; Mental Disorders - ethnology; Mental Disorders - therapy; Mental health care; Mental health services; Mental Health Services - statistics & numerical data; Nurse practitioners; Nurse Practitioners - statistics & numerical data; Original Paper; Pediatrics; Polls & surveys; Psychiatry; Psychologists; Race; Racial differences; Racial Groups - statistics & numerical data; Racial inequality; Regulation; United States
• ISSN: 0010-3853; 1573-2789; 1573-2789
• DOI: 10.1007/s10597-024-01310-6

To examine the association between scope-of-practice (SoP) regulations and racial disparities in pediatric mental health services. We used the National Survey of Children’s Health (2016–2020; n  = 33,790) to examine racial disparities in unmet mental health care needs and receipt of mental health medication between states with and without SoP expansions for psychologists and nurse practitioners (NP). Our primary outcomes were (1) unmet mental health care needs and (2) receipt of mental health medication. We examined heterogeneous treatment effects of SoP expansion on the outcomes using logistic regression with interaction terms between SoP expansion and race/ethnicity. We estimated population-level racial disparities for both outcomes stratified by SoP expansion to identify differences in racial disparities. The psychologist SoP expansion-associated reduction in unmet need was 15.8 percentage-points (CI= -25.3, -6.2) larger for Other-race children than for White children. The psychologist SoP expansion-associated increase in medication was 5.1%-points (CI=. 0.8, 9.4) larger for Black children and 5.6%-points (CI = 0.5, 10.8) for Other-race children. No differences were found for NP SoP expansion. Racial disparities in both outcomes were lower in psychologist SoP expansion states but varied in NP SoP states. Expanded SoP was generally associated with lower racial disparities in pediatric mental health care access.