Matthew J. Carlson

Protective Orders and Domestic Violence: Risk Factors for Re-Abuse

One of the few legal tools for protecting victims of domestic violence is the civil Protection Order (PO). How effective they were in preventing re-abuse was analyzed by examining court and police records from 210 couples in which female victims (or “applicants”) filed POs against their violent partners. Police records for 2 years prior and two years following the issuance of a PO were reviewed. Results indicated a significant decline in the probability of abuse following a PO. Prior to filing a PO, 68% of the women reported physical violence. After filing, only 23% reported physical violence. Several risk factors were assessed and it was found that very low SES women were more likely to report re-abuse as were African-Americans.

Use of complementary and alternative medicine practitioners by people with physical disabilities: Estimates from a National US Survey

Purpose. To estimate the prevalence of complementary and alternative medicine (CAM) practitioner use, assess the reasons for use, and determine the symptoms for which CAM practitioners were consulted in a national US sample of insured adults with physical disabilities. Methods. Data for this study come from a longitudinal survey conducted in 2000 and 2001 on a national sample of 830 adults with health insurance who had one of four disabling conditions: multiple sclerosis, cerebral palsy, spinal cord injury, and arthritis. Estimates of annual prevalence and reasons and symptoms for which CAM practitioners were consulted are derived from cross-sectional analysis of the 2001 survey data. Prior use of CAM was assessed using the 2000 survey. Results. CAM practitioners were consulted by 19% of the sample, a rate similar to, or higher than the general population. CAM use was more prevalent among women than men (24 vs. 10%), in the Western US (30%) compared to the Midwest (20%) Northeast (14%), and South (10%) and among prior users (62%) compared to non-users (8%). There were no significant differences in CAM use by condition, although individuals with spinal cord injury reported the lowest use (14%). Common symptoms treated were pain (80%), decreased functioning (43%), and lack of energy (24%). Common reasons for using CAM practitioners included lifestyle choice (67%) and because they are perceived to be more effective than conventional medicine (44%). Conclusions. Evidence from the current survey suggests that a significant proportion of people with physical disabilities consult CAM practitioners. Many of those who use CAM do so because it fits their lifestyle and because they perceive it to be more effective than conventional medicine for treating common symptoms including pain and decreased functioning.

Reducing Domestic Violence Revictimization

This article examines the role of individual and contextual factors and legal interventions in reducing time to domestic violence revictimization. Drawing on current theory and research, hypotheses are deduced about the effects of these factors. Cox regression and survival analyses are employed to test the hypotheses using court, police, and census data from an urban jurisdiction in Texas. Prior drug use, race/ethnicity, and community-level income were associated with time to revictimization. However, there was little evidence either of interactive effects between race/ethnicity and community-level income or of differential effects of each of three types of legal interventions. Implications for theory, research, and domestic violence interventions are discussed.

The Individual and Program Impacts of Eliminating Medicaid Dental Benefits in the Oregon Health Plan

OBJECTIVES We determined how elimination of dental benefits among adult Medicaid beneficiaries in Oregon affected their access to dental care, Medicaid expenditures, and use of medical settings for dental services. METHODS We used a natural experimental design using Medicaid claims data (n = 22 833) before and after Medicaid dental benefits were eliminated in Oregon in 2003 and survey data for continuously enrolled Oregon Health Plan enrollees (n = 718) covering 3 years after benefit cuts. RESULTS Claims analysis showed that, compared with enrollees who retained dental benefits, those who lost benefits had large increases in dental-related emergency department use (101.7%; P < .001) and expenditures (98.8%; P < .001) and in all ambulatory medical care use (77.0%; P < .01) and expenditures (114.5%; P < .01). Survey results indicated that enrollees who lost dental benefits had nearly 3 times the odds (odds ratio = 2.863; P = .001) of unmet dental need, and only one third the odds (odds ratio = 0.340; P = .001) of getting annual dental checkups relative to those retaining benefits. CONCLUSIONS Combined evidence from both analyses suggested that the elimination of dental benefits resulted in significant unmet dental health care needs, which led to increased use of medical settings for dental problems.

Satisfaction With Provider Communication Among Spanish-Speaking Medicaid Enrollees

OBJECTIVE To determine if differences between English- and Spanish-speaking parents in ratings of their childrens health care can be explained by need for interpretive services. METHODS Using the Consumer Assessment of Health Plans Survey-Child-Survey (CAHPS), reports about provider communication were compared among 3 groups of parents enrolled in a Medicaid managed care health plan: 1) English speakers, 2) Spanish speakers with no self-reported need for interpretive services, and 3) Spanish speakers with self-reported need for interpretive services. Parents were asked to report how well their providers 1) listened carefully to what was being said, 2) explained things in a way that could be understood, 3) respected their comments and concerns, and 4) spent enough time during medical encounters. Multivariate logistic regression was used to compare the ratings of each of the 3 groups while controlling for childs gender, parents gender, parents educational attainment, childs health status, and survey year. RESULTS Spanish-speaking parents in need of interpretive services were less likely to report that providers spent enough time with their children (odds ratio = 0.34, 95% confidence interval = 0.17-0.68) compared to English-speaking parents. There was no statistically significant difference found between Spanish-speaking parents with no need of interpretive services and English-speaking parents. CONCLUSIONS Among Spanish- versus English-speaking parents, differences in ratings of whether providers spent enough time with children during medical encounters appear to be explained, in part, by need for interpretive services. No other differences in ratings of provider communication were found.

Access to publicly funded methadone maintenance treatment in two western states.

This study examined individual and system characteristics associated with access to methadone maintenance treatment (MMT) among Medicaid-eligible adults entering treatment for opiate use in Oregon and Washington. Logistic regression was used to examine the relative contributions of predisposing, need, and enabling characteristics on access to MMT. Although the number of methadone admissions increased in both states, access rates (the percentage of opiate-using adults presenting for treatment who were placed on methadone) declined after 1995. Adults in remote counties were one fifth to one tenth as likely to be placed in a methadone maintenance program than those living in counties with a methadone clinic. Other significant barriers to access included polydrug use, legal system referral, residence in a group home, lack of income, and homelessness. Factors promoting access included prior methadone use, pregnancy, and self-referral to treatment. These results suggest that more can be done to expand access to methadone maintenance.

The impact of managed care on publicly funded outpatient adolescent substance abuse treatment: service use and six-month outcomes in Oregon and Washington.

This study assessed the impact of managed care on publicly funded adolescent substance abuse treatment by comparing differences in service utilization and outcomes across prospective samples from two states: Oregon, which uses managed care practices in service financing and delivery, and Washington, which does not. One hundred and six adolescents from Washington and 94 from Oregon, who entered outpatient substance abuse treatment in 1998 and 1999, completed self-report surveys about their substance use before and after receiving treatment (follow-up rate = 75 percent). In addition, clinical chart reviews conducted at the 6-month follow-up assessed the type and amount of treatment these adolescents received during the study period. It was found that service utilization and treatment outcomes were comparable across the two state samples. The evidence presented here suggests that managed care is capable of delivering substance abuse treatment services of comparable quality to state-administered substance abuse treatment services.