Presentation 3: Racial Differences in Child Psychiatric Hospitalization Referral: The Role of Community Factors

Objective: To investigate whether community factors explain racial differences in child psychiatric hospitalization referral. Design: Secondary analysis of retrospective cohort data. Setting: Community-based. Participants: Children (5 to 18 years of age) screened by the Illinois Screening, Assessment, and Support Services (SASS) program from December 1, 2005 to August 31, 2006, who had not been previously screened (N=5116). Interventions: Not applicable. Main Outcome Measures: SASS crisis worker decision to refer for psychiatric hospitalization. Results: In comparison with white children, black (adjusted odds ratio [AOR]=1.43, 95% confidence interval (CI), 1.24−1.66) and Hispanic, Asian, Native American, or bi-racial (AOR=1.40; 95% CI, 1.14−1.72) children were more likely to be referred for psychiatric hospitalization. When community factors and their interactions with race were included in the analysis, racial differences in psychiatric hospital referral rates were eliminated. Community poverty (AOR=0.66; 95% CI, .55−.79) and urbanicity (AOR=2.58; 95% CI, 1.98−3.36) appear to explain racial differences in psychiatric hospitalization referral rates. Conclusions: Community factors appear to account for racial differences in psychiatric hospitalization referral rates in a system of care.