Racial Disparities in Children's Use of Special Education and Mental Health Services
Open Access
- Author:
- Ochai, Sule
- Graduate Program:
- Health Policy and Administration
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- May 14, 2007
- Committee Members:
- Marianne Messersmith Hillemeier, Committee Chair/Co-Chair
E Michael Foster, Committee Member
John Casterline, Committee Member
Gregory Dean Hanson, Committee Member
Rebecca Wells, Committee Member
Rhonda Belue, Committee Member - Keywords:
- restrictive placement
mental health
special education
survival analysis - Abstract:
- This dissertation uses event history and multivariate logistic regression analyses to examine the risk of children’s use and level of placement in special education and mental health services in the US. Three separate but thematically related studies are presented. The first study examines the dynamics of black and white children’s use of special education services. The second study examines factors that explain racial/ethnic disparities in children’s use of special education and mental health services. The third study examines factors that explain racial/ethnic disparities in restrictive placement of children in special education and mental health services. The data used in the three studies were collected as part of the Fast Track Project, a longitudinal study of children at risk for emotional and/or behavioral problems conducted in four locations: Durham, North Carolina; Nashville, Tennessee; rural Pennsylvania; and Seattle, Washington. The first study investigates whether the hazards of children’s use of special education services vary by race/ethnicity, gender and location. The findings show that racial/ethnic, and gender differences characterize students’ use of, and exit from special education services among the high-risk sample used in this investigation. In addition, the shape of the hazards of students’ entry and exit from services by race/ethnicity, gender and location is nonlinear, displaying periods of increasing or decreasing risk. The findings highlight the need to develop special education programs and service delivery systems that are cognizant of racial/ethnic and gender differences. The findings also call for a more tailored special education system that takes into account the timing when children are most likely to need services. The second study has two objectives: 1) to evaluate the factors that explain children’s use of special education and mental health services, and 2) to examine whether the factors that explain special education and mental health services use differ by race/ethnicity. Cox regression models are estimated to test the study hypotheses. Results of race-only predictor models show statistically significant racial disparities in special education in two sites (Durham and Washington). Similarly, racial differences in mental health services use were found in Nashville and Pennsylvania. Controlling for several predisposing, enabling and need covariates diminished the observed racial disparities in special education and mental health services use. A policy implication of these findings is that a one-size-fits-all social policy is not likely to achieve the federal government’s goal of eliminating racial and ethnic disparities in children’s use of social and health services in the US. Partial support was found for the hypothesis that predictors of children’s use of special education and mental health services are different amongst the two racial groups analyzed. Variables that predict black children’s use of both types of services are generally different from those of whites. The two exceptions are teachers’ report of children’s behavioral problems and a measure of academic performance, which are the same for each group. The objectives of the third study are also twofold: 1) to evaluate factors that predict children’s placement in restrictive settings of special education and mental health services; and 2) to examine whether restrictive placement predictors in special education and mental health services differ by race/ethnicity. Multivariate logistic regression models were estimated to test the study’s hypotheses. Gender disparities in restrictive placement of children in both special education and mental health services persist after “fully” adjusting the models with predisposing, enabling and need factors. Racial/ethnic disparity persists in the full model in the context of restrictive special education placement but is statistically insignificant in the context of inpatient mental health service placement. This suggests that other variables not fully captured in the present study underlie the observed differences in black and white children’s level of placement in special education. In sum, racial/ethnic disparities are found in children’s use of special education and mental health services and in restrictiveness of placement. Service use and placement also vary by gender and geographic location, and variables that predict service use and placement vary by race/ethnicity. These findings suggest that children’s special education and mental health service delivery systems should be examined so as to be as culturally competent as possible. Policies are needed to address the observed inequalities in children’s placement and use of special education and mental health services, as well as the underlying social and economic disadvantages that confront black children and their caregivers/parents.