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Scope-of-Practice Expansions Associated with Reduced Racial Disparities in Pediatric Mental Health Care
Phillip M Hughes1,2,3,4, Genevive Graaf5, Kristin H Gigli6
1Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA. phughes1@email.unc.edu.
Insights
Expanding scope-of-practice (SoP) for psychologists reduced unmet mental health needs and increased medication receipt for racial/ethnic minority children. Nurse practitioner SoP expansion showed no similar impact on disparities.
Area of Science:
- Health Services Research
- Health Disparities
- Pediatric Mental Health Policy
Background:
- Racial and ethnic disparities persist in pediatric mental health care access.
- Scope-of-practice (SoP) regulations for healthcare professionals may influence these disparities.
- Understanding the impact of SoP expansions on equitable care is crucial.
Purpose of the Study:
- To investigate the association between SoP regulations for psychologists and nurse practitioners (NPs) and racial disparities in pediatric mental health services.
- To determine if SoP expansions affect unmet mental health care needs and medication receipt differently across racial/ethnic groups.
Main Methods:
- Analysis of the National Survey of Children's Health (2016-2020; n=33,790).
- Comparison of outcomes in states with and without SoP expansions for psychologists and NPs.
- Logistic regression with interaction terms to examine heterogeneous treatment effects by race/ethnicity.
Main Results:
- Psychologist SoP expansion significantly reduced unmet mental health needs more for 'Other-race' children compared to White children.
- Psychologist SoP expansion increased mental health medication receipt more for Black and 'Other-race' children than White children.
- No significant impact on racial disparities was observed for nurse practitioner SoP expansion.
Conclusions:
- Expanded scope-of-practice for psychologists is associated with reduced racial disparities in pediatric mental health care access.
- Policy implications suggest that specific professional SoP expansions can mitigate inequities in child mental healthcare.
- Further research is needed to understand the varied effects of NP SoP expansions.
Abstract:
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.
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