When those children come from low-income households with limited English proficiency, there can be significant barriers in getting them the care they need.

A recent 91探花 found that less than 20 percent of rehabilitation providers in the state accepted Medicaid and also provided language interpretation to children with traumatic brain injuries. Just 8 percent provided mental health services to those children, and Spanish-speaking families had to travel significantly further to access services.

The findings highlight how already disadvantaged children are further impacted by limited access to the rehabilitation services that vastly improve long-term outcomes, said lead author , the Sidney Miller Endowed Assistant Professor in Direct Practice at the 91探花School of Social Work and a core faculty member at the 91探花.

鈥淩ehabilitation after a brain injury is incredibly important, especially for kids with moderate to severe brain injuries,鈥� Moore said. 鈥淯ltimately, that limited availability is going to impact children鈥檚 outcomes.鈥�

For the study, published in the in March, the researchers compiled a database of 293 health providers around Washington offering physical and occupational therapy; speech, language and cognitive therapy; and mental health services. A research assistant called each provider and asked about the types of services offered, whether Medicaid was accepted and if interpretation was available for non-English-speaking families.

The research found that:

• Only 46 percent of providers accepted children with Medicaid
• Children covered by Medicaid had fewer rehabilitation services available than those covered by private insurance
• In each of the three general areas of health care listed above, there were fewer services for children whose families needed language interpretation
• While mental health services comprised more than half of the rehabilitation services available, only 8 percent of those providers accepted children with Medicaid who needed language services
• Less than half of the physical and occupational services accepted children with Medicaid and provided language services
• In total, less than 20 percent of all providers accepted children with Medicaid and also provided language services

The researchers also looked at travel times for 82 children with moderate to severe traumatic brain injuries who were treated at Harborview Medical Center, using data from a study. They found that regardless of their child鈥檚 insurance status, Spanish-speaking parents had to drive an average of 16 minutes more than English-speaking parents to reach a mental health provider, and they had to travel an additional nine minutes to get to physical, occupational, speech and cognitive therapy.

The study found that more diverse counties also had fewer multilingual rehabilitation services 鈥� for every 10 percent increase in of non-English speakers over the age of 5 at home, there was a 34 percent drop in the availability of those services.

The inequities may be even greater than the study shows, the researchers note, since providers who accept Medicaid may routinely limit the number of Medicaid-covered children that they accept, due to lower reimbursement rates.

The study follows earlier 91探花 which found disparities in outcomes among Latino children after traumatic brain injuries. The researchers wondered whether the disparities might have to do with a lack of rehabilitation services generally, but instead identified an access issue for low-income children from families with limited English proficiency.

That gap is particularly worrisome given the state鈥檚 increasing diversity 鈥� more than 18 percent of households in Washington spoke a language other than English in 2012, the study notes, and almost half of children younger than 18 had Medicaid insurance in 2011.

Joana Ramos, co-chair of the , said advocates regularly hear that families are being turned away from health care providers or being required to provide their own interpreters.

鈥淚t鈥檚 a huge problem, and we definitely need to get everybody on board to address it, not just the advocates,鈥� she said. 鈥淟anguage services need to be a routine part of health care services, not a standalone thing.鈥�

Moore said since the bulk of rehabilitation after a brain injury takes place in the community, workers at the hospitals where children are initially treated should try to connect parents with services before they leave.

鈥淲e need to be thinking more critically about how we transition kids back to the community, particularly children we know have limited access to services,鈥� she said. 鈥淲e really have to do a thorough job of linking them to these services on the outpatient side.

鈥淜nowing what we know now, it鈥檚 a social justice obligation.鈥�

The research was funded by the National Center for Advancing Translational Sciences of the National Institutes of Health and the National Institute of Child Health and Human Development.

Co-authors are , an anesthesiologist at Children鈥檚 Hospital; , an assistant professor of epidemiology at the 91探花School of Public Health; , a graduate student at Boston College; Kate Baron, a research assistant at Harborview Injury Prevention Center; , director of support programs at the Brain Injury Alliance of Washington; , executive director of the Brain Injury Alliance of Washington; , professor and vice president of academic affairs at the 91探花Department of Pediatrics; , a professor of rehabilitation medicine and adjunct professor of pediatrics and neurological surgery at 91探花Medicine; and , a 91探花professor of pediatrics.

For more information, contact Moore at mm99@uw.edu or 206-616-2862.

A 91探花 researcher has found that a 20-minute conversation with a social worker has the potential to significantly reduce the functional decline of those diagnosed with a mild traumatic brain injury.

The is published in the April issue of .

in the UW’s is training social workers in emergency departments to provide education and resources to patients with mild traumatic brain injuries to help them deal with symptoms and the recovery process.

“Social workers are masters-level trained clinicians who are already embedded in emergency room treatment teams,” Moore said. “The goal of my work is to provide them with specialized training on mild traumatic brain injuries to help bridge the psychological and social aspects of treatment with medical care.”

Traumatic brain injury occurs when the head is hit by an outside force, causing the brain to move rapidly within the skull, altering consciousness and damaging the nervous system. Anyone who experiences a fall, car or bike accident, sports head injury or an assault, may experience a traumatic brain injury, but most are considered mild.

While a serious traumatic brain injury is usually obvious, mild brain injuries are often harder to detect, and can cause unexplained physical, cognitive, behavioral or emotional symptoms. Typical symptoms 鈥� nausea, vomiting, dizziness, headache, blurred vision, fatigue and sleep disturbances 鈥� are common in many other diagnoses, or resolve quickly, and patients don’t always seek medical care.

If a patient does go to the emergency room to be evaluated, he or she may go home thinking they’re physically OK, but then continue to have trouble with memory, depression, or completing once-routine tasks. That makes it all the more important that a social worker completes an evaluation while the patient is still in the emergency room, Moore said.

“It’s a critical intervention point not only for the patients with mild traumatic brain injuries, but also for patients with other types of medical and psychosocial problems,” she said.

Moore, who joined the 91探花in the fall of 2012, also is affiliated with the r. While conducting her doctoral research at the University of California, Berkeley, she designed a that is currently running at San Francisco General Hospital, a Level 1 Trauma Center. There, medical staff identify patients with mild traumatic brain injuries and refer them to social workers, who provide education, coping strategies, resources and a brief alcohol intervention screening. Social workers later follow up with a phone call to see how the patient is doing.

Moore’s initial study showed that an intervention lasting less than 20 minutes significantly reduced brain injury patients’ alcohol use and prevented functional decline. (A second, randomized trial is now under way.)

Moore said social workers already conduct evaluations and provide resources for patients in hospitals and emergency rooms, and would need only a small amount of training on recognizing and dealing with mild traumatic brain injuries. They could provide patients with education about symptoms and the recovery process, as well as coping strategies such as getting enough rest and avoiding alcohol and drugs (which increase the risk of re-injury). Social workers also link patients to support groups, counselors, substance abuse services and appropriate medical care.

Moore is especially concerned with thousands of soldiers returning from the battlefield with such brain injuries. The estimated that more than 220,000 U.S. service members were diagnosed with traumatic brain injuries between 2000 and the third quarter of 2011; 77 percent were considered mild. Such cases may not be detected or treated immediately because of more serious battlefield injuries taking precedence, and once the patients return home they may not report to a hospital for follow-up care.

“Soldiers are coming back with different issues than civilian populations that are injured in a car accident,” Moore said. “Social workers definitely need to know the unique issues of soldiers coming back from the battlefield.”

# # #

Moore can be reached at mm99@uw.edu or 206-616-2862.

Moore’s research is funded in part by the Institute of Translational Health Sciences at the UW, NIH grant KL2 TR000421-06.