State Variation in Racial and Ethnic Disparities in Children’s Mental Health Access

Genevieve Graaf; Lonnie Snowden

doi:10.1176/appi.ps.20240279

. Author manuscript; available in PMC: 2026 Sep 2.

Published in final edited form as: Psychiatr Serv. 2025 Aug 14;76(9):809–817. doi: 10.1176/appi.ps.20240279

State Variation in Racial and Ethnic Disparities in Children’s Mental Health Access

Genevieve Graaf ^a,^*, Lonnie Snowden ^b

PMCID: PMC13533552 NIHMSID: NIHMS2094522 PMID: 40808377

Abstract

Objectives:

Black-white and Hispanic-white mental health treatment disparities are well documented among children and youth. This study examined state variation in Black and Hispanic versus whites’ disparities in caregiver reported unmet mental health need and difficulties in accessing mental healthcare among children and youth.

Methods:

Using a retrospective cross-sectional design, this study drew on the National Survey of Children’s Health, pooling data from years 2016–2019. Logistic regression with marginal post-estimation, using complex survey weights to reflect state and national probabilities, estimated the direction, size, and significance of disparities between Black and white children (n=5,900) and Hispanic and white children (n=10,369).

Results:

Adjusted state estimates of disparities show a significant (at p<0.05) Black-white disparities in probabilities of unmet mental health need in three states. Reverse Black-white disparities in difficulty accessing care were found in four states. In one state, caregivers of Black children were significantly more likely than those of white children to report difficulty accessing treatment. Caregivers of Hispanic children were significantly less likely to report unmet need for mental healthcare than their white counterparts in seven states, but the opposite was found in one state. The probability of reporting difficulty accessing care was significantly lower for caregivers of Hispanic children than caregivers of white children in two states, but higher in three states.

Conclusions:

Significant state variation in disparities is obscured in national averages. Findings highlight a need for more policy and systems analysis, especially at state levels, to uncover structural drivers of disparities in children’s mental health treatment.

Background

Children and youth with unmet mental health needs are at increased risk for behavioral health concerns as an adult,¹ resulting in unstable relationships and employment, substance use, justice system involvement, and fragile health in adulthood.² Entrenched racial and ethnic disparities in behavioral health need and service use place racially and ethnically minoritized children and youth in the United States (U.S.) at disproportionately higher risk for these negative outcomes. Estimates of racial and ethnic disparities in mental health treatment for children and youth vary in size and scope, but disparities are consistently notable in magnitude and longevity for Black children.³ Black children are significantly more likely than their white counterparts to report unmet mental health need.^4–6 Hispanic-white differences are smaller^5,6 and primarily observable in psychiatric medication use³ and for those with specific diagnoses.⁴

Contextual Drivers of Mental Health Access for Children and Youth

To explain these disparities, researchers have focused on individual or community factors, pointing to the cultural competence of providers, culturally-specific community mental health stigma, symptom recognition, logistical barriers, limited English proficiency, or socioeconomic differences.⁷ Evidence suggests, however, that residential location may also contribute to disparities. Geographic variation in children’s mental health service use and unmet need are well established,^8,9 and geographic variation in racial and ethnic mental health access disparities have been observed in adults.¹⁰ However, state-level variation in racial and ethnic disparities in mental health treatment for children has not yet been documented, possibly limiting scholarly attention to sociopolitical environments and geographic contexts as drivers of mental health disparities.¹¹ Examining these geographic differences may reveal locations, obscured in national averages, in which disparities are particularly stark or in which mental health equity has been achieved. Findings can indicate state systems to target for further examination, intervention, or to view as potential models for scale up to other locations.

This study examined the role that state of residence may play in unmet mental healthcare need and difficulty accessing mental health services among racially/ethnically diverse children and youth with mental health need in the United States (U.S.). Based on prior evidence,^5,9 we hypothesized that 1) Black and Hispanic children would have higher rates of unmet mental health need and difficulty accessing care nationwide, but that 2) these racial and ethnic disparities in mental health access would vary across states.

Method

This study used a retrospective cross-sectional design with pooled data from the National Survey of Children’s Health (NSCH) for the years 2016 through 2019, accessed in April of 2023. The NSCH is a population-based parent survey that collects information on children’s health status, healthcare access and quality, family access to community supports, and the qualities of their social context. The survey is sampled and weighted to allow for accurate state estimates when using 2 years of data or more.^12,13 Detailed information about the NSCH methodology, sampling, weighting procedures, and variables are described in publicly available documentation.¹² Drawing on publicly available de-identified data, this study does not constitute human subjects research.

To capture the customary level of mental health disparities among children, the research team excluded the years 2020 through 2022 from this study. Documented widening racial and ethnic disparities in mental health need and service use during the COVID-19 pandemic¹⁴ suggests that combining data from prior to and during COVID-19 may result in estimates that fail to correctly represent system circumstances for either period.

Sample and Measures

To estimate disparities, this study analyzes only the subsample of children with a caregiver-reported need for mental healthcare. The study’s primary predictor of interest was the combined caregiver-reported race or ethnicity of the child. The NSCH’s four-level “race/ethnic” variable was used. This included the following options: “Hispanic,” “non-Hispanic White,” “non-Hispanic Black,” and “non-Hispanic Other/Multiracial.” (For brevity, the term “non-Hispanic” will be dropped from here forward, referring only to White, Black, and Other/Multiracial.) Observations for children identified as Other/Multiracial, which were too few to allow for state level disparity estimates, were excluded from the sample (n=16,832). As such, this study focused only on Hispanic-white and Black-white disparities. The secondary predictor of interest was state of residence, which is reported for each child in the NSCH. This study focused on two outcomes: caregiver-reported unmet need for mental healthcare and difficulty accessing mental healthcare. Exhibit A in the online supplement illustrates the construction of the analytic sample and outcome variables.

Analysis

Estimates were generated using the subsample of children identified as 1) having a reported need for mental healthcare, and 2) identifying as Black, White, or Hispanic. Due to insufficient sample sizes for weighting procedures, the U.S. Census Bureau does not recommend generating state population estimates for several states for both Black and Hispanic populations. As such, models assessing Black-white disparities included only 24 states and D.C., resulting in an analytic sample size of 5,900. Models assessing Hispanic-white disparities included 40 states and D.C., resulting in a sample size of 10,369. States included in each analysis are listed in Figures 1 through 4.

Figure 1. — Data Source: National Survey of Children’s Health, 2016–2019; Proportions are weighted to be state representative; n=5,900

Adjusted Models controlled for child sex, age, impairments in daily activities, insurance type, gaps in insurance, family poverty level, family structure, household language, highest caregiver education level, and survey year

Exhibit B provides state predicted probabilities for each racial group and reports the disparity between groups.

^a Among children with parent reported need for mental healthcare; Disparity between Black and white children in this state is significant at p<.05; ** significant at p<.01; *** significant at p<.001; † significant at p<0.10

Figure 4. — Data Source: National Survey of Children’s Health, 2016–2019; Proportions are weighted to be state representative; n=10,369

Adjusted Models controlled for child sex, age, impairments in daily activities, insurance type, gaps in insurance, family poverty level, family structure, household language, highest caregiver education level, and survey year

Exhibit C provides state predicted probabilities for each racial group and reports the disparity between groups.

^a Among children with parent reported need for mental healthcare; Disparity between Hispanic and white children in this state is significant at p<.05; ** significant at p<.01; *** significant at p<.001; † significant at p<0.10

Analyses were conducted using STATA v.16.1 (StataCorp, College Station, TX). Stratified univariate and bivariate analysis assessed the distribution of outcome and sociodemographic variables across child racial and ethnic groups nationwide. Logistic regression models interacted state with race and ethnicity and controlled for child and family covariates (child sex, age, impairments in daily activities, insurance type, gaps in insurance, family poverty level, family structure, household language, highest caregiver education level) and a year fixed effect. Models excluded state-level covariates because the NSCH sampling and weighting design inherently controls for state level demographics.¹⁵ Marginal post-estimation generated adjusted predicted probabilities of caregiver-reported child unmet need for mental healthcare and difficulty accessing mental healthcare for each racial and ethnic group nationwide, and for each included state. National estimates were generated using all fifty states and Washington D.C.

For each state, the size and significance of the disparity in predicted probabilities between Black and white children and between Hispanic and white children were calculated and assessed using the postestimation contrast command. This command contrasts estimates from factor variables and interactions, calculating differences between estimates for each level of the variable and the reference group estimate. It uses ANOVA-style tests to assess the significance of interaction effects. Models accounted for the NCSH’s complex survey methodology using survey clustering, stratification, and weighting to create nationally representative and state representative results. As missingness was limited in our study (unmet need and difficulty receiving treatment<0.005%), we used a complete-case method for handling missing data; this tactic does not limit the population representativeness of survey data analyses, as long as missingness is 10% or less.¹⁶

Results

National sample characteristics are reported in Table 1. Disparities are reported as significant (p<0.05) and as nearing significance (p<0.10). Rates of unmet need and difficulty accessing care vary significantly across racial and ethnic groups (p<0.001), with African American children having the highest rates of unmet need and difficulty accessing care (p<0.03). Marginal estimates, confidence intervals, and disparity sizes and significance for all models are reported in the online supplement (Exhibits B & C). Figure 1 illustrates variation in the size and direction of Black-white disparities in unmet mental health need for children across states, compared with the national disparity estimate. Nationwide, the probability of reporting unmet mental health need was 12 points higher for Black children than for white children (p<0.001). However, in 5 states, the probability of Black children having unmet mental health needs was lower than that of white children—though this difference failed to reach statistically significant levels. Adjusted state estimates of Black-white disparities in unmet mental health need are significant (at p<0.05) in Delaware (0.18), New Jersey (0.32), South Carolina (0.26), and Texas (0.29), with disparities in Washington D.C. (0.14), Maryland (0.19), Illinois (0.18), and Pennsylvania ( 0.19) nearing significance (at p<0.10).

Table 1.

Sample Characteristics by Race and Ethnicity: Children with Mental Health Needs, 2016–2019

	Full Sample n=14,607	White, Non-Hispanic n=11,663	Hispanic n=1,853	African American, Non-Hispanic n=1,763	p^*

Unmet Mental Health Need					<0.001
No Unmet Need	80.8%	84.9%	78.1%	70.0%
Unmet Need	19.2%	15.1%	21.9%	30.0%
Difficulty Accessing Care					0.033
Not a Problem	56.0%	58.4%	53.1%	51.8%
Any type of Problem	44.0%	41.7%	46.9%	48.2%
Sex					0.315
Male	53.9%	52.9%	53.8%	57.5%
Female	46.1%	47.1%	46.2%	42.5%
Age					0.001
0–5 years	54.9%	6.2%	7.4%	11.2%
6–11 years	7.4%	38.1%	35.7%	39.6%
12–17 years	37.8%	55.7%	56.9%	49.2%
Family Income					<0.001
0–199%	28.4%	35.1%	60.5%	70.1%
200–299%	47.1%	15.3%	15.2%	11.0%
300–399%	14.6%	12.1%	7.2%	6.3%
400% FPL and Up	9.9%	37.5%	17.2%	12.7%
Impairment in Daily Activities					0.026
None or no condition	47.5%	48.0%	50.4%	41.4%
Moderate to Severe	52.5%	52.0%	49.6%	58.6%
Gaps in Insurance					<0.001
Insured all 12 months	91.8%	95.0%	87.5%	87.1%
Insured during the past 12 months but with Gaps	4.2%	2.8%	5.8%	6.8%
No coverage past 12 months	4.0%	2.2%	6.8%	6.1%
Insurance Type					<0.001
Private Only	48.1%	60.5%	33.7%	24.4%
Public Only	39.3%	29.4%	50.4%	58.3%
Private and Public	7.5%	7.3%	6.4%	9.8%
Not Insured	5.2%	2.8%	9.5%	7.4%
Family Structure					<0.001
Two Parent Family	58.9%	66.5%	59.1%	31.6%
Single Parent or Other	41.1%	33.5%	40.9%	68.4%
Primary Language					<0.001
English	91.6%	98.7%	69.8%	97.9%
Spanish	7.1%	0.4%	28.8%	0.0%
Other	1.3%	1.0%	1.5%	2.1%
Highest Level of Education Among Reported Adults					<0.001
More than High School	69.2%	79.0%	53.2%	58.0%
Less Than High School	9.6%	4.9%	19.4%	12.1%
High School Graduate	21.1%	16.1%	27.4%	29.9%

Open in a new tab

Data Source: National Survey of Children’s Health, 2016–2019

Using a chi-square test of independence

Figure 2 displays the size and direction of Black-white disparities in caregiver reported difficulty accessing mental health treatment across states, comparing them to the national disparity. Nationally, caregivers of Black children were more likely (by 4 points) than caregivers of white children to report having difficulty accessing mental healthcare, but this difference was not significant. At the state level, caregivers of Black children were significantly less likely to report difficulty accessing care than their white counterparts in Delaware (−0.24), New York (0.21), Tennessee (−0.18), and Oklahoma (−0.16). In Texas, Black-white disparities were significant (0.46).

Figure 3 shows the nature and scope of Hispanic-white disparities in unmet mental health needs in children. Nationally, there appeared to be no disparity (−0.003) in the probability of reporting unmet mental health need between caregivers of Hispanic versus white children. When examined at the state level, caregivers of Hispanic children were significantly less likely to report unmet need for mental healthcare than their white counterparts in seven states: Wisconsin (−0.17), New York (−0.16), North Carolina (−0.16), Maryland (−0.14), Idaho (−0.14), Tennessee (0.14), and Connecticut (−.014), nearing significance in Oregon (−0.11). However, the opposite held true in in one state (Illinois, at 0.21) and neared significance in Arkansas (0.24).

Figure 4 shows the size and direction of Hispanic-white disparities in the probability of caregiver reported difficulty accessing mental healthcare across states. Nationally, caregivers of Hispanic children were more likely to report difficulty accessing mental health treatment (by 5 percentage points), but this disparity was only marginally significant. The probability of reporting difficulty accessing mental healthcare was significantly lower for caregivers of Hispanic children compared to that of white children in Utah (−0.23) and New Mexico (−.019) and neared significance in Ohio (−0.19), Hawaii (−0.14), and D.C. (−0.23). Caregivers of Hispanic children had significantly higher probability of reporting difficulty accessing care compared to caregivers of white children in Connecticut (0.21), Illinois (0.26), and Mississippi (0.38).

Exhibit D in the online supplement provides a summary of state-level disparities found in this study, highlighting states with statistically significant disparities and patterns across and within states. Delaware and Texas are the only states that have significant Black-white disparities for both outcomes, though the disparity in difficulty accessing treatment is reversed in Delaware. Maryland, New Jersey, South Carolina, D.C., Illinois, Maryland and Pennsylvania have significant or marginal Black-white disparities for unmet mental health need, but not for difficulty accessing care. New York, Oklahoma and Tennessee do not have Black-white disparities in unmet mental health need but have reverse disparities in difficulty accessing care. Regarding Hispanic-white disparities, Illinois and Connecticut both have disparities for both outcomes, though the disparity is reversed for unmet mental health need in Connecticut. Arkansas has near significant Hispanic-white disparities in unmet mental health need, but no significant disparities in difficulty accessing care. Idaho, Maryland, North Carolina, New York, Tennessee, Wisconsin, and Oregon all have significant or marginal reverse disparities for unmet mental health need, but no significant disparities in difficulty accessing care. New Mexico, Utah, Hawaii, Ohio and D.C. have significant or marginal reversed disparities in difficulty accessing care, but no disparities in unmet mental health need. Mississippi has a notable Hispanic-white disparity in difficulty accessing care, but no disparity in unmet mental health need.

Discussion

Consistent with existing research,^4–6 national Hispanic-white mental health treatment disparities for children were smaller than Black-white disparities. Across states, disparities for both groups varied widely in size and direction—ranging from white families reporting greater access difficulties and unmet need than Black and Hispanic families in some states, and the reverse in others. In several states, disparities were reversed for Black children but not for Hispanic children—or vice versa. In some states, disparities were reversed for unmet mental health need, but not for difficulty accessing care—or vice versa. Reverse Black-white disparities were more common for difficulty accessing care, with this disparity being observed in four states; a Black-white disparity was only noted in one state for this outcome. In contrast, Hispanic-white reverse disparities in difficulty accessing care were only observed in two states, while large disparities were observed in three states for this outcome.

This variation is obscured in national averages but has significant implications for children and families whose chances of accessing mental healthcare are disadvantaged by where they reside. To result in national averages that favor whites, reverse disparities must be offset by disparities much greater than the national average in other states. Given the potentially compounding effects of geography, this means that Hispanic or Black families experiencing other risk factors for unmet mental health need (e.g., chronic health conditions, disability, or lack of insurance, transportation, or other resources¹⁷), may have even greater risk of unmet mental health need if living in states with especially large disparities.

Possible Drivers of Racial and Ethnic Disparities in Child Mental Health Services

At the national level, Black-white disparities in unmet need are notably larger than those for difficulty accessing care. This may indicate that barriers to services (e.g., distance to providers, administrative or financial burdens) are more similar for Black and white families. However, resources (e.g., material, emotional, social) for overcoming those barriers may be greater for whites. Alternatively, logistical barriers may play a smaller role in whether Black children utilize behavioral healthcare.⁷ This is consistent with existing research that finds, despite equal rates of endorsement for specific barriers to treatment across racial and ethnic groups, Hispanic and Black youth have higher rates of unmet mental health need.¹⁸

Geographic variations in the supply of behavioral health providers¹⁹ and norms and values related to behavioral health²⁰ may impact also mental health service use among children. States also have significant freedom in the design and operation of their Medicaid and the Children’s Health Insurance Program (CHIP)—the largest payers for children’s mental healthcare²¹—and their child welfare, juvenile justice, and special education systems.^22–24 Mental health treatment is often identified, funded, and sometimes delivered through these programs – through outpatient, in-home, residential, or school settings.²⁵ State authorities over these sectors set program eligibility and quality standards, and establish and monitor processes for referral, intake, and delivery of mental healthcare through these systems.^22–24 Differences in states’ design of these programs, as well as their funding strategies and allocations for these programs, contribute to variation in the physical, administrative, and financial burdens families face in accessing care.^25–27 States’ use of Medicaid managed care, mental health parity laws, Medicaid home and community-based services waiver programs, regulations on where services can be located or provided, reimbursement rates, and total spending have all been associated with use of, or ease of access to, mental health treatment for children and youth.^26,28–32

Because racially and ethnically minoritized children are over-represented in low-income families, and thus in many social safety net programs,^33–35 they are particularly vulnerable to variations in the welfare policies that finance and organize care for youth. County level studies have found that Medicaid spending, public contracting with culturally competent local providers, and expansions of safety net healthcare providers are linked with reduced racial and ethnic disparities in mental health treatment.^36,37 State developmental and mental health screening practices, prescribing regulations for providers, use of home and community-based Medicaid waivers, and Medicaid spending and eligibility policies have also been associated with reduced racial and ethnic disparities in children’s mental service use and unmet healthcare needs.^37–42

Examining patterns of disparities in and across individual states provides evidence that different policy environments may engender different disparity trends. In New Jersey, Black-white disparities are large for unmet mental health need. However, New Jersey’s near neighbor, New York, has no disparities for unmet mental health need and reversed disparities for difficulty accessing care. One potential explanation for the glaring differences between nearby states is that New York organizes and finances a great deal of mental healthcare through Medicaid, whereas New Jersey relies on state general fund allocations for this.²⁵ Thus, disparity differences may reflect income distributions across racial and ethnic subgroups within these states and related racial disparities in public health coverage—which offers greater mental health benefits than commercial insurance⁴³ and is associated with reduced rates of unmet mental health needs in the general population.⁴⁴ Further, New York offers a home and community-based Medicaid waiver for children with mental health needs³²—a policy which has been connected with reductions in racial disparities in unmet needs.³⁹

Limitations.

To the author’s knowledge, this study provides the first documentation of state variation in racial and ethnic disparities in children’s access to mental healthcare. Future research should build on these findings by assessing what state policy, economic, and systemic factors drive the differences in race-based mental health disparities reported here. This study is limited by its reliance on caregiver report for all outcome measures rather than clinical assessments or measures of need for services or ease of treatment access. Further, the measure of mental health service use in this study specified treatment from a mental health professional. Thus, the measure may exclude children or youth who access mental health care through primary healthcare settings.³⁷ Finally, in some states, differences between racial or ethnic subgroups that were large may have failed to meet statistical significance due to small Black or Hispanic sample sizes.

Conclusion

Additional possible explanations for patterns of mental health treatment disparities are too numerous to consider more broadly and deeply in the space provided here. Sources of disparities are likely multiplicative, too; Due to differential representation across states—reflecting a complex national history of policies, laws, and local practices related to slavery, colonization, segregation and migration—Black and Hispanic families may differ from whites in exposure to less favorable ideologies and related state policies and treatment resources.⁴⁵ Provision of virtual mental healthcare is also proliferating in the wake of COVID-19, and this trend—which is authorized to varying degrees across mental health service sectors and states—may impact racial and ethnic mental healthcare disparities moving forward. Thorough investigation of Black-white and Hispanic-white disparities in perceived unmet need and accessibility of care requires a comprehensive program of research with state-level structures and characteristics as an influential level of analysis. Such efforts can help to identify and modify social, policy, and financing levers capable of reducing these disparities.

Highlights:

Racial/ethnic mental health treatment disparities are well documented for children. Though variations in state children’s mental health care policies and population distributions may differentially impact racial and ethnic minority children, geographic variation in these disparities have not been documented.
Drawing on state and nationally representative survey data, this study examined state variation in racial and ethnic disparities children’s mental health care access.
Disparities ranged from whites reporting greater access difficulties and unmet need than Black and Hispanic children in some states, and the reverse in other states. Significant state variation in disparities is obscured in national averages.

Funding:

Dr. Graaf was supported in part by the National Institute of Mental Health of the National Institutes of Health under Award Number 1K01MH129991. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr. Snowden received no additional funding.

Role of Funder/Sponsor:

The funder/sponsor did not participate in the work.

Footnotes

Conflict of Interest Disclosures: The authors have no conflicts of interest relevant to this article to disclose.

References

1.Copeland W, Shanahan L, Costello EJ, Angold A. Cumulative prevalence of psychiatric disorders by young adulthood: A prospective cohort analysis from the Great Smoky Mountains Study. Journal of the American Academy of Child & Adolescent Psychiatry. 2011;50(3):252–261. doi: 10.1016/j.jaac.2010.12.014 [DOI] [PMC free article] [PubMed] [Google Scholar]
2.Costello EJ, Copeland W, Angold A. The Great Smoky Mountains Study: Developmental epidemiology in the southeastern United States. Soc Psychiatry Psychiatr Epidemiol. 2016;51(5):639–646. doi: 10.1007/s00127-015-1168-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
3.Bitsko RH. Mental Health Surveillance Among Children — United States, 2013–2019. MMWR Suppl. 2022;71. doi: 10.15585/mmwr.su7102a1 [DOI] [PMC free article] [PubMed] [Google Scholar]
4.Chang AR, Slopen N. Racial and ethnic disparities for unmet needs by mental health condition: 2016 to 2021. Pediatrics. Published online December 5, 2023:e2023062286. doi: 10.1542/peds.2023-062286 [DOI] [PubMed] [Google Scholar]
5.Rodgers CRR, Flores MW, Bassey O, Augenblick JM, Cook BL. Racial/ethnic disparity trends in children’s mental health care access and expenditures from 2010–2017: Disparities remain despite sweeping policy reform. Journal of the American Academy of Child & Adolescent Psychiatry. 2022;61(7):915–925. doi: 10.1016/j.jaac.2021.09.420 [DOI] [PMC free article] [PubMed] [Google Scholar]
6.Marrast L, Himmelstein DU, Woolhandler S. Racial and ethnic disparities in mental health care for children and young adults: A national study. Int J Health Serv. 2016;46(4):810–824. doi: 10.1177/0020731416662736 [DOI] [PubMed] [Google Scholar]
7.Lu W, Todhunter-Reid A, Mitsdarffer ML, Muñoz-Laboy M, Yoon AS, Xu L. Barriers and facilitators for mental health service use among racial/ethnic minority adolescents: A systematic review of literature. Frontiers in Public Health. 2021;9. Accessed September 28, 2022. https://www.frontiersin.org/articles/10.3389/fpubh.2021.641605 [DOI] [PMC free article] [PubMed]
8.Winckler B, Nguyen M, Khare M, et al. Geographic variation in acute pediatric mental health utilization. Academic Pediatrics. Published online August 6, 2022. doi: 10.1016/j.acap.2022.07.026 [DOI] [PubMed] [Google Scholar]
9.Graaf G, Hughes PM, Gigli KH, deJong NA, McGrath RE, Thomas KC. State differences in children’s mental health care. Academic Pediatrics. 2025;25(2):102585. doi: 10.1016/j.acap.2024.09.009 [DOI] [PMC free article] [PubMed] [Google Scholar]
10.Kim G, Dautovich N, Ford KL, et al. Geographic variation in mental health care disparities among racially/ethnically diverse adults with psychiatric disorders. Soc Psychiatry Psychiatr Epidemiol. 2017;52(8):939–948. doi: 10.1007/s00127-017-1401-1 [DOI] [PubMed] [Google Scholar]
11.Cook BL, Hou SSY, Lee-Tauler SY, Progovac AM, Samson F, Sanchez MJ. A review of mental health and mental health care disparities research: 2011–2014. Med Care Res Rev. 2019;76(6):683–710. doi: 10.1177/1077558718780592 [DOI] [PMC free article] [PubMed] [Google Scholar]
12.Ghandour RM, Jones JR, Lebrun-Harris LA, et al. The design and implementation of the 2016 National Survey of Children’s Health. Matern Child Health J. 2018;22(8):1093–1102. doi: 10.1007/s10995-018-2526-x [DOI] [PMC free article] [PubMed] [Google Scholar]
13.2020 National Survey of Children’s Health: Data Users Frequently Asked Questions (FAQs). U.S. Census Bureau; 2021. Accessed January 18, 2024. https://www2.census.gov/programs-surveys/nsch/technical-documentation/methodology/2020-NSCH-FAQs.pdf [Google Scholar]
14.Prichett LM, Yolken RH, Severance EG, et al. COVID-19 and youth mental health disparities: Intersectional trends in depression, anxiety and suicide risk-related diagnoses. Academic Pediatrics. 2024;24(5):837–847. doi: 10.1016/j.acap.2024.01.021 [DOI] [PMC free article] [PubMed] [Google Scholar]
15.2019 National Survey of Children’s Health: Methodology Report. United State Census Bureau; 2020. Accessed April 21, 2022. https://www.census.gov/content/dam/Census/programs-surveys/nsch/tech-documentation/methodology/2017-NSCH-Methodology-Report.pdf [Google Scholar]
16.Langkamp DL, Lehman A, Lemeshow S. Techniques for handling missing data in secondary analyses of large surveys. Acad Pediatr. 2010;10(3):205–210. doi: 10.1016/j.acap.2010.01.005 [DOI] [PMC free article] [PubMed] [Google Scholar]
17.Eijgermans DGM, Fang Y, Jansen DEMC, Bramer WM, Raat H, Jansen W. Individual and contextual determinants of children’s and adolescents’ mental health care use: A systematic review. Children and Youth Services Review. 2021;131:106288. doi: 10.1016/j.childyouth.2021.106288 [DOI] [Google Scholar]
18.Yeh M, McCabe K, Hough RL, Dupuis D, Hazen A. Racial/ethnic differences in parental endorsement of barriers to mental health services for youth. Ment Health Serv Res. 2003;5(2):65–77. doi: 10.1023/A:1023286210205 [DOI] [PubMed] [Google Scholar]
19.Thomas KC, Ellis AR, Konrad TR, Holzer CE, Morrissey JP. County-level estimates of mental health professional shortage in the United States. PS. 2009;60(10):1323–1328. doi: 10.1176/ps.2009.60.10.1323 [DOI] [PubMed] [Google Scholar]
20.Wrigley S, Jackson H, Judd F, Komiti A. Role of stigma and attitudes toward help-seeking from a general practitioner for mental health problems in a rural town. Aust N Z J Psychiatry. 2005;39(6):514–521. doi: 10.1080/j.1440-1614.2005.01612.x [DOI] [PubMed] [Google Scholar]
21.Rudowitz R, Burns A, Hinton E, Mohamed M. 10 Things to Know About Medicaid. Kaiser Family Foundation; 2023. https://www.kff.org/mental-health/issue-brief/10-things-to-know-about-medicaid/ [Google Scholar]
22.Testa MF, Kelly D. The evolution of federal child welfare policy through the Family First Prevention Services Act of 2018: Opportunities, barriers, and unintended consequences. The ANNALS of the American Academy of Political and Social Science. 2020;692(1):68–96. doi: 10.1177/0002716220976528 [DOI] [Google Scholar]
23.Elliott DS, Buckley PR, Gottfredson DC, Hawkins JD, Tolan PH. Evidence-based juvenile justice programs and practices: A critical review. Criminology & Public Policy. 2020;19(4):1305–1328. doi: 10.1111/1745-9133.12520 [DOI] [Google Scholar]
24.Guth M, Saunders H, Corallo B, Moreno S. Medicaid Coverage of Behavioral Health Services in 2022: Findings from a Survey of State Medicaid Programs.; 2023. Accessed September 15, 2023. https://www.kff.org/mental-health/issue-brief/medicaid-coverage-of-behavioral-health-services-in-2022-findings-from-a-survey-of-state-medicaid-programs/
25.Graaf G, Snowden L. State approaches to funding home and community-based mental health care for non-Medicaid youth: Alternatives to Medicaid waivers. Adm Policy Ment Health. 2019;46(4):530–541. doi: 10.1007/s10488-019-00933-2 [DOI] [PubMed] [Google Scholar]
26.So M, McCord RF, Kaminski JW. Policy levers to promote access to and utilization of children’s mental health services: A systematic review. Adm Policy Ment Health. 2019;46(3):334–351. doi: 10.1007/s10488-018-00916-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
27.Graaf G, Snowden L. State strategies for enhancing access and quality in systems of care for youth with complex behavioral health needs. Adm Policy Ment Health. Published online July 7, 2020. doi: 10.1007/s10488-020-01061-y [DOI] [PubMed] [Google Scholar]
28.Thomas KC, Parish SL, Rose RA, Kilany M. Access to care for children with autism in the context of state Medicaid reimbursement. Matern Child Health J. 2012;16(8):1636–1644. doi: 10.1007/s10995-011-0862-1 [DOI] [PubMed] [Google Scholar]
29.Hu JC, Cummings JR, Ji X, Wilk AS. State-level variation in Medicaid managed care enrollment and specialty care for publicly insured children. JAMA Network Open. 2023;6(10):e2336415. doi: 10.1001/jamanetworkopen.2023.36415 [DOI] [PMC free article] [PubMed] [Google Scholar]
30.Robinson RJ, Palka JM, Brown ES. The Relationship Between State Mental Health Agency and Medicaid Spending with Outcomes. Community Ment Health J. Published online June 4, 2020. doi: 10.1007/s10597-020-00649-w [DOI] [PubMed] [Google Scholar]
31.Graaf G, Snowden L, Keyes L. Medicaid waivers for youth with Severe Emotional Disturbance: Associations with public health coverage, unmet mental health needs & adequacy of health coverage. Community Ment Health J. Published online January 25, 2021. doi: 10.1007/s10597-020-00759-5 [DOI] [PubMed] [Google Scholar]
32.Graaf G, Snowden L. Medicaid waivers and public sector mental health service penetration rates for youth. American Journal of Orthopsychiatry. 2018;88(5):597–607. doi: 10.1037/ort0000295 [DOI] [PubMed] [Google Scholar]
33.Zane SN. Have racial and ethnic disparities in juvenile justice declined over time? An empirical assessment of the DMC mandate. Youth Violence and Juvenile Justice. 2021;19(2):163–185. doi: 10.1177/1541204020962163 [DOI] [Google Scholar]
34.Putnam-Hornstein E, Needell B, King B, Johnson-Motoyama M. Racial and ethnic disparities: A population-based examination of risk factors for involvement with child protective services. Child Abuse & Neglect. 2013;37(1):33–46. doi: 10.1016/j.chiabu.2012.08.005 [DOI] [PubMed] [Google Scholar]
35.Grindal T, hifter LA, Schwartz G, Hehir T. Racial differences in special education identification and placement: Evidence across three states. Harvard Educational Review. 2019;89(4):525–553. doi: 10.17763/1943-5045-89.4.525 [DOI] [Google Scholar]
36.Bruckner TA, Singh P, Yoon J, Chakravarthy B, Snowden LR. African American/white disparities in psychiatric emergencies among youth following rapid expansion of Federally Qualified Health Centers. Health Services Research. 2020;55(1):26–34. doi: 10.1111/147-56773.13237 [DOI] [PMC free article] [PubMed] [Google Scholar]
37.Snowden LR, Wallace N, Cordell K, Graaf G. Increased mental health treatment financing, community-based organization’s treatment programs, and Latino-White children’s financing disparities. J Ment Health Policy Econ. 2017;20(3):137–145. [PubMed] [Google Scholar]
38.Snowden LR, Wallace N, Cordell K, Graaf G. Increased Medicaid financing and equalization of African Americans’ and whites’ outpatient and emergency treatment expenditures. J Ment Health Policy Econ. 2016;19(3):167–174. [PubMed] [Google Scholar]
39.LaClair M, Mandell DS, Dick AW, Iskandarani K, Stein BD, Leslie DL. The effect of Medicaid waivers on ameliorating racial/ethnic disparities among children with autism. Health Services Research. 2019;54:912–919. doi: 10.1111/1475-6773.13176 [DOI] [PMC free article] [PubMed] [Google Scholar]
40.Lonquich B, Camp EA, Fredricks K, Russell EA. State-specific Medicaid/CHIP eligibility criteria and their impact on health care access for foreign-born children living in the United States. Journal of Health Care for the Poor and Underserved. 2023;34(1):345–356. doi: 10.1353/hpu.2023.0023 [DOI] [PubMed] [Google Scholar]
41.Barger B, Salmon A, Chödrön G. Correlations between state-level monitoring and screening rates and early identified ASD/DD across racial and ethnic groups: Analyses from the National Survey of Children’s Health. Infants & Young Children. 2024;37(1):64. doi: 10.1097/IYC.0000000000000258 [DOI] [Google Scholar]
42.Hughes PM, Graaf G, Gigli KH, deJong NA, McGrath RE, Thomas KC. Scope-of-practice expansions associated with reduced racial disparities in pediatric mental health care. Community Mental Health Journal. Published online 2024. doi: 10.1007/s10597-024-01310-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
43.Graaf G, Palmer AN. Parent ratings of health insurance adequacy for children with emotional, behavioral, or developmental problems. Academic Pediatrics. 2022;23(6):1204–1212. doi: 10.1016/j.acap.2022.10.020 [DOI] [PMC free article] [PubMed] [Google Scholar]
44.Graaf G, Snowden L. Public health coverage and access to mental health care for youth with complex behavioral healthcare needs. Adm Policy Ment Health. 2020;47(3):395–409. doi: 10.1007/s10488-019-00995-2 [DOI] [PubMed] [Google Scholar]
45.Chin HB, Howards PP, Kramer MR, Johnson CY. Understanding the roles of state demographics and state policies in epidemiologic studies of maternal-child health disparities. American Journal of Epidemiology. Published online December 5, 2023:kwad240. doi: 10.1093/aje/kwad240 [DOI] [PubMed] [Google Scholar]

[R1] 1.Copeland W, Shanahan L, Costello EJ, Angold A. Cumulative prevalence of psychiatric disorders by young adulthood: A prospective cohort analysis from the Great Smoky Mountains Study. Journal of the American Academy of Child & Adolescent Psychiatry. 2011;50(3):252–261. doi: 10.1016/j.jaac.2010.12.014 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R2] 2.Costello EJ, Copeland W, Angold A. The Great Smoky Mountains Study: Developmental epidemiology in the southeastern United States. Soc Psychiatry Psychiatr Epidemiol. 2016;51(5):639–646. doi: 10.1007/s00127-015-1168-1 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R3] 3.Bitsko RH. Mental Health Surveillance Among Children — United States, 2013–2019. MMWR Suppl. 2022;71. doi: 10.15585/mmwr.su7102a1 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R4] 4.Chang AR, Slopen N. Racial and ethnic disparities for unmet needs by mental health condition: 2016 to 2021. Pediatrics. Published online December 5, 2023:e2023062286. doi: 10.1542/peds.2023-062286 [DOI] [PubMed] [Google Scholar]

[R5] 5.Rodgers CRR, Flores MW, Bassey O, Augenblick JM, Cook BL. Racial/ethnic disparity trends in children’s mental health care access and expenditures from 2010–2017: Disparities remain despite sweeping policy reform. Journal of the American Academy of Child & Adolescent Psychiatry. 2022;61(7):915–925. doi: 10.1016/j.jaac.2021.09.420 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R6] 6.Marrast L, Himmelstein DU, Woolhandler S. Racial and ethnic disparities in mental health care for children and young adults: A national study. Int J Health Serv. 2016;46(4):810–824. doi: 10.1177/0020731416662736 [DOI] [PubMed] [Google Scholar]

[R7] 7.Lu W, Todhunter-Reid A, Mitsdarffer ML, Muñoz-Laboy M, Yoon AS, Xu L. Barriers and facilitators for mental health service use among racial/ethnic minority adolescents: A systematic review of literature. Frontiers in Public Health. 2021;9. Accessed September 28, 2022. https://www.frontiersin.org/articles/10.3389/fpubh.2021.641605 [DOI] [PMC free article] [PubMed]

[R8] 8.Winckler B, Nguyen M, Khare M, et al. Geographic variation in acute pediatric mental health utilization. Academic Pediatrics. Published online August 6, 2022. doi: 10.1016/j.acap.2022.07.026 [DOI] [PubMed] [Google Scholar]

[R9] 9.Graaf G, Hughes PM, Gigli KH, deJong NA, McGrath RE, Thomas KC. State differences in children’s mental health care. Academic Pediatrics. 2025;25(2):102585. doi: 10.1016/j.acap.2024.09.009 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R10] 10.Kim G, Dautovich N, Ford KL, et al. Geographic variation in mental health care disparities among racially/ethnically diverse adults with psychiatric disorders. Soc Psychiatry Psychiatr Epidemiol. 2017;52(8):939–948. doi: 10.1007/s00127-017-1401-1 [DOI] [PubMed] [Google Scholar]

[R11] 11.Cook BL, Hou SSY, Lee-Tauler SY, Progovac AM, Samson F, Sanchez MJ. A review of mental health and mental health care disparities research: 2011–2014. Med Care Res Rev. 2019;76(6):683–710. doi: 10.1177/1077558718780592 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R12] 12.Ghandour RM, Jones JR, Lebrun-Harris LA, et al. The design and implementation of the 2016 National Survey of Children’s Health. Matern Child Health J. 2018;22(8):1093–1102. doi: 10.1007/s10995-018-2526-x [DOI] [PMC free article] [PubMed] [Google Scholar]

[R13] 13.2020 National Survey of Children’s Health: Data Users Frequently Asked Questions (FAQs). U.S. Census Bureau; 2021. Accessed January 18, 2024. https://www2.census.gov/programs-surveys/nsch/technical-documentation/methodology/2020-NSCH-FAQs.pdf [Google Scholar]

[R14] 14.Prichett LM, Yolken RH, Severance EG, et al. COVID-19 and youth mental health disparities: Intersectional trends in depression, anxiety and suicide risk-related diagnoses. Academic Pediatrics. 2024;24(5):837–847. doi: 10.1016/j.acap.2024.01.021 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R15] 15.2019 National Survey of Children’s Health: Methodology Report. United State Census Bureau; 2020. Accessed April 21, 2022. https://www.census.gov/content/dam/Census/programs-surveys/nsch/tech-documentation/methodology/2017-NSCH-Methodology-Report.pdf [Google Scholar]

[R16] 16.Langkamp DL, Lehman A, Lemeshow S. Techniques for handling missing data in secondary analyses of large surveys. Acad Pediatr. 2010;10(3):205–210. doi: 10.1016/j.acap.2010.01.005 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R17] 17.Eijgermans DGM, Fang Y, Jansen DEMC, Bramer WM, Raat H, Jansen W. Individual and contextual determinants of children’s and adolescents’ mental health care use: A systematic review. Children and Youth Services Review. 2021;131:106288. doi: 10.1016/j.childyouth.2021.106288 [DOI] [Google Scholar]

[R18] 18.Yeh M, McCabe K, Hough RL, Dupuis D, Hazen A. Racial/ethnic differences in parental endorsement of barriers to mental health services for youth. Ment Health Serv Res. 2003;5(2):65–77. doi: 10.1023/A:1023286210205 [DOI] [PubMed] [Google Scholar]

[R19] 19.Thomas KC, Ellis AR, Konrad TR, Holzer CE, Morrissey JP. County-level estimates of mental health professional shortage in the United States. PS. 2009;60(10):1323–1328. doi: 10.1176/ps.2009.60.10.1323 [DOI] [PubMed] [Google Scholar]

[R20] 20.Wrigley S, Jackson H, Judd F, Komiti A. Role of stigma and attitudes toward help-seeking from a general practitioner for mental health problems in a rural town. Aust N Z J Psychiatry. 2005;39(6):514–521. doi: 10.1080/j.1440-1614.2005.01612.x [DOI] [PubMed] [Google Scholar]

[R21] 21.Rudowitz R, Burns A, Hinton E, Mohamed M. 10 Things to Know About Medicaid. Kaiser Family Foundation; 2023. https://www.kff.org/mental-health/issue-brief/10-things-to-know-about-medicaid/ [Google Scholar]

[R22] 22.Testa MF, Kelly D. The evolution of federal child welfare policy through the Family First Prevention Services Act of 2018: Opportunities, barriers, and unintended consequences. The ANNALS of the American Academy of Political and Social Science. 2020;692(1):68–96. doi: 10.1177/0002716220976528 [DOI] [Google Scholar]

[R23] 23.Elliott DS, Buckley PR, Gottfredson DC, Hawkins JD, Tolan PH. Evidence-based juvenile justice programs and practices: A critical review. Criminology & Public Policy. 2020;19(4):1305–1328. doi: 10.1111/1745-9133.12520 [DOI] [Google Scholar]

[R24] 24.Guth M, Saunders H, Corallo B, Moreno S. Medicaid Coverage of Behavioral Health Services in 2022: Findings from a Survey of State Medicaid Programs.; 2023. Accessed September 15, 2023. https://www.kff.org/mental-health/issue-brief/medicaid-coverage-of-behavioral-health-services-in-2022-findings-from-a-survey-of-state-medicaid-programs/

[R25] 25.Graaf G, Snowden L. State approaches to funding home and community-based mental health care for non-Medicaid youth: Alternatives to Medicaid waivers. Adm Policy Ment Health. 2019;46(4):530–541. doi: 10.1007/s10488-019-00933-2 [DOI] [PubMed] [Google Scholar]

[R26] 26.So M, McCord RF, Kaminski JW. Policy levers to promote access to and utilization of children’s mental health services: A systematic review. Adm Policy Ment Health. 2019;46(3):334–351. doi: 10.1007/s10488-018-00916-9 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R27] 27.Graaf G, Snowden L. State strategies for enhancing access and quality in systems of care for youth with complex behavioral health needs. Adm Policy Ment Health. Published online July 7, 2020. doi: 10.1007/s10488-020-01061-y [DOI] [PubMed] [Google Scholar]

[R28] 28.Thomas KC, Parish SL, Rose RA, Kilany M. Access to care for children with autism in the context of state Medicaid reimbursement. Matern Child Health J. 2012;16(8):1636–1644. doi: 10.1007/s10995-011-0862-1 [DOI] [PubMed] [Google Scholar]

[R29] 29.Hu JC, Cummings JR, Ji X, Wilk AS. State-level variation in Medicaid managed care enrollment and specialty care for publicly insured children. JAMA Network Open. 2023;6(10):e2336415. doi: 10.1001/jamanetworkopen.2023.36415 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R30] 30.Robinson RJ, Palka JM, Brown ES. The Relationship Between State Mental Health Agency and Medicaid Spending with Outcomes. Community Ment Health J. Published online June 4, 2020. doi: 10.1007/s10597-020-00649-w [DOI] [PubMed] [Google Scholar]

[R31] 31.Graaf G, Snowden L, Keyes L. Medicaid waivers for youth with Severe Emotional Disturbance: Associations with public health coverage, unmet mental health needs & adequacy of health coverage. Community Ment Health J. Published online January 25, 2021. doi: 10.1007/s10597-020-00759-5 [DOI] [PubMed] [Google Scholar]

[R32] 32.Graaf G, Snowden L. Medicaid waivers and public sector mental health service penetration rates for youth. American Journal of Orthopsychiatry. 2018;88(5):597–607. doi: 10.1037/ort0000295 [DOI] [PubMed] [Google Scholar]

[R33] 33.Zane SN. Have racial and ethnic disparities in juvenile justice declined over time? An empirical assessment of the DMC mandate. Youth Violence and Juvenile Justice. 2021;19(2):163–185. doi: 10.1177/1541204020962163 [DOI] [Google Scholar]

[R34] 34.Putnam-Hornstein E, Needell B, King B, Johnson-Motoyama M. Racial and ethnic disparities: A population-based examination of risk factors for involvement with child protective services. Child Abuse & Neglect. 2013;37(1):33–46. doi: 10.1016/j.chiabu.2012.08.005 [DOI] [PubMed] [Google Scholar]

[R35] 35.Grindal T, hifter LA, Schwartz G, Hehir T. Racial differences in special education identification and placement: Evidence across three states. Harvard Educational Review. 2019;89(4):525–553. doi: 10.17763/1943-5045-89.4.525 [DOI] [Google Scholar]

[R36] 36.Bruckner TA, Singh P, Yoon J, Chakravarthy B, Snowden LR. African American/white disparities in psychiatric emergencies among youth following rapid expansion of Federally Qualified Health Centers. Health Services Research. 2020;55(1):26–34. doi: 10.1111/147-56773.13237 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R37] 37.Snowden LR, Wallace N, Cordell K, Graaf G. Increased mental health treatment financing, community-based organization’s treatment programs, and Latino-White children’s financing disparities. J Ment Health Policy Econ. 2017;20(3):137–145. [PubMed] [Google Scholar]

[R38] 38.Snowden LR, Wallace N, Cordell K, Graaf G. Increased Medicaid financing and equalization of African Americans’ and whites’ outpatient and emergency treatment expenditures. J Ment Health Policy Econ. 2016;19(3):167–174. [PubMed] [Google Scholar]

[R39] 39.LaClair M, Mandell DS, Dick AW, Iskandarani K, Stein BD, Leslie DL. The effect of Medicaid waivers on ameliorating racial/ethnic disparities among children with autism. Health Services Research. 2019;54:912–919. doi: 10.1111/1475-6773.13176 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R40] 40.Lonquich B, Camp EA, Fredricks K, Russell EA. State-specific Medicaid/CHIP eligibility criteria and their impact on health care access for foreign-born children living in the United States. Journal of Health Care for the Poor and Underserved. 2023;34(1):345–356. doi: 10.1353/hpu.2023.0023 [DOI] [PubMed] [Google Scholar]

[R41] 41.Barger B, Salmon A, Chödrön G. Correlations between state-level monitoring and screening rates and early identified ASD/DD across racial and ethnic groups: Analyses from the National Survey of Children’s Health. Infants & Young Children. 2024;37(1):64. doi: 10.1097/IYC.0000000000000258 [DOI] [Google Scholar]

[R42] 42.Hughes PM, Graaf G, Gigli KH, deJong NA, McGrath RE, Thomas KC. Scope-of-practice expansions associated with reduced racial disparities in pediatric mental health care. Community Mental Health Journal. Published online 2024. doi: 10.1007/s10597-024-01310-6 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R43] 43.Graaf G, Palmer AN. Parent ratings of health insurance adequacy for children with emotional, behavioral, or developmental problems. Academic Pediatrics. 2022;23(6):1204–1212. doi: 10.1016/j.acap.2022.10.020 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R44] 44.Graaf G, Snowden L. Public health coverage and access to mental health care for youth with complex behavioral healthcare needs. Adm Policy Ment Health. 2020;47(3):395–409. doi: 10.1007/s10488-019-00995-2 [DOI] [PubMed] [Google Scholar]

[R45] 45.Chin HB, Howards PP, Kramer MR, Johnson CY. Understanding the roles of state demographics and state policies in epidemiologic studies of maternal-child health disparities. American Journal of Epidemiology. Published online December 5, 2023:kwad240. doi: 10.1093/aje/kwad240 [DOI] [PubMed] [Google Scholar]

PERMALINK

State Variation in Racial and Ethnic Disparities in Children’s Mental Health Access

Genevieve Graaf, PhD, MSW

Lonnie Snowden, PhD