Journal
AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION
Volume 95, Issue 3, Pages 204-213Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/PHM.0000000000000362
Keywords
Disability; Health Care Accessibility; Rehabilitation; Health Care Disparities; Hispanic Children; Brain Injuries
Categories
Funding
- National Center for Advancing Translational Sciences of the National Institutes of Health [KL2TR000421]
- National Institute of Child Health and Human Development [1K23HD078453-01]
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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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