Article

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.

Langue : ANGLAIS