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Objective: The objective of this study was to explore associations between English proficiency, insurance status, outpatient rehabilitation service availability, and travel time for children with traumatic brain injury., Design: The authors used an ecologic cross-sectional design. Data were analyzed from a cohort of 82 children with moderate to severe traumatic brain injury and rehabilitation providers in Washington State. Main measures included availability and travel time to services., Results: Less than 20% of providers accepted children with Medicaid and provided language interpretation. Mental health services were most limited. Adjusted for median household income, multilingual service availability was lowest in counties with greater language diversity; for every 10% increase in persons older than 5 yrs speaking a language other than English at home, there was a 34% decrease in availability of multilingual services (prevalence ratio, 0.66; 95% confidence interval, 0.48-0.90). Adjusted for education and Medicaid status, children from Spanish-speaking families had significantly longer travel times to services (mean, 16 additional minutes to mental health; 9 to other therapies)., Conclusions: Children in households with limited English proficiency and Medicaid faced significant barriers in availability and proximity of outpatient rehabilitation services. Innovative service strategies are needed to equitably improve availability of rehabilitation for children with traumatic brain injury. Similar studies in other regions will inform one's understanding of the scope of these disparities.

Objective: To compare motor and cognitive functional independence scores between Hispanic, non-Hispanic black (NHB), and non-Hispanic white (NHW) children with traumatic brain injury (TBI) after discharge from inpatient rehabilitation., Design: Retrospective cohort study using the Uniform Data System for Medical Rehabilitation national dataset from the years 2002 to 2012., Setting: Inpatient rehabilitation units., Participants: Children (N=10,141) aged 6 months to 18 years who received inpatient rehabilitation for TBI., Interventions: Not applicable., Main Outcome Measures: Motor and cognitive functional independence after discharge from inpatient rehabilitation, adjusting for age, sex, admission function, length of stay, insurance, and region., Results: Inpatient rehabilitation therapy improved functional independence for all children. Younger age, lower admission functional independence scores, and Medicaid insurance were associated with lower functional independence at discharge. Hispanic and NHB children had lower discharge cognitive scores compared with NHW children; however, differences were small and were partially explained by insurance status and region. Children who received rehabilitation therapy at pediatric facilities had greater cognitive improvement., Conclusions: While racial/ethnic disparities are small, minority children are more likely to be younger, to have Medicaid, and to be cared for at nonpediatric facilities, factors that increase their risk for lower functional outcomes., (Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To compare the extent of disability in multiple areas of functioning after mild, moderate, and severe traumatic brain injury (TBI) between Hispanic and non-Hispanic white (NHW) children., Methods: This was a prospective cohort study of children aged <18 years treated for a TBI between March 1, 2007, and September 30, 2008. Hispanic (n = 74) and NHW (n = 457) children were included in the study. Outcome measures were disability in health-related quality of life, adaptive skills, and participation in activities 3, 12, 24, and 36 months after injury compared with preinjury functioning. We compared change in outcome scores between Hispanic and NHW children at each follow-up time. All analyses were adjusted for age, gender, severity and intent of injury, insurance, family function at baseline, parental education, and income., Results: The health-related quality of life for all children was lower at all follow-up times compared with baseline. Although NHW children showed some improvement during the first 3 years after injury, Hispanic children remained significantly impaired. Significant differences were also observed in the domains of communication and self-care abilities after TBI. Differences between groups in scores for participation in activities were also present but were only significant 3 months after injury., Conclusions: Hispanic children with TBI report larger and long-term reductions in their quality of life, participation in activities, communication, and self-care abilities compared with NHW children. The reasons for these differences need to be better understood and interventions implemented to improve the outcomes of these children.

BACKGROUND: Return to school is key for community re-integration after a traumatic brain injury (TBI). School support facilitates and ensure a successful transition back to school. However, access to school services is not uniform among U.S. children. OBJECTIVE: To describe school services for children with TBI from minoritized backgrounds and highlight population-specific risk factors and facilitators for accessing services. METHODS: Narrative review of the literature including studies on return to school after a mild-complicated, moderate, or severe TBI, among children enrolled in the U.S. school system. We describe receipt of services, enabling and risk factors, and outcomes, for minority children. RESULTS: There is a gap in knowledge regarding return to school among minoritized children with TBIs. Studies have few participants from racial and ethnic minority backgrounds, or low income or rural communities. Transgender and non-binary youth are not represented in present research efforts. Studies highlight larger barriers to receipt of school services among minority children and additional barriers associated with their minority status. CONCLUSION: Diversity in the U.S pediatric population is increasing. Minoritized populations are at increased risk for TBI and poor outcomes. Research focused on the needs of these populations is required to optimize school return after TBI hospitalization and overall post-discharge care. [ABSTRACT FROM AUTHOR]

While Hispanic children experience large long-term disparities in disability after traumatic Brain Injury (TBI), there is a gap in evidenced-based interventions to improve outcomes among this rapidly growing and at high-risk population. We developed and pilot tested a bilingual/bicultural intervention informed by Hispanic families consisting of Brain Injury Education and outpatient Navigation (1st BIEN). It integrates bilingual in-person education enriched by video content delivered through mobile phone devices, with outpatient navigation by bilingual and bicultural navigators during transitions of care and school return. Randomized controlled trial to test the efficacy of 1st BIEN to maintain long-term adherence to rehabilitation and determine its effect on children's functional outcomes. The primary outcome is treatment adherence at 6 months post-discharge at centralized acute facilities and community providers. Secondary outcomes are functional status of the child using PROMIS parental report measures and parental health literacy, self-efficacy, and mental health; measured at baseline (pre-injury and discharge) 3-,6- and 12- months post discharge. Children's academic performance is assessed using school records the year before and the year after injury. Our study evaluates a novel, flexible and scalable approach using mobile phone devices to aid transitions of care, increase treatment adherence and improve TBI outcomes. It addresses the needs of an understudied population and builds upon their strengths. It is implemented by a bilingual and bicultural team with a deep understanding of the study population. It can serve as a model for TBI family centered interventions for at risk groups. Trial registration: ClinicalTrials.gov NCT05261477. Registered on March 2, 2022. [ABSTRACT FROM AUTHOR]

BACKGROUND: School reintegration after traumatic brain injuries (TBI) requires school support; however, implementation of services is complex. This study evaluates disparities in receipt of school services for Hispanic children and its effect on academic performance. METHODS: Secondary analyses of school data on receipt of pre‐ and post‐TBI school services. A logistic regression compared receipt of services between Hispanic and non‐Hispanic white (NHW) children, and a linear regression evaluated services' effect on academic performance. RESULTS: The study includes 419 children; 46 Hispanic, 373 NHW. For NHW children there were no differences in receipt of pre‐ and post‐TBI services; Hispanic children had significant increase in receipt of services from 5% to 27% (p < .001). Compared to NHWs, Hispanics had lower grade point average (GPA) at baseline (2.3 [confidence interval, CI: 1.9‐2.7] vs 2.9 [CI: 2.8‐3.0]). No differences in GPA were found between groups after injury among students who received post‐TBI services. CONCLUSIONS: Students who receive post‐TBI school services benefit academically. NHW students maintain their academic performance and Hispanics increase their performance to their NHW peers' level. This highlights the importance of providing post‐TBI school services to ensure better outcomes for all children. [ABSTRACT FROM AUTHOR]

Objectives: To compare health care costs and service utilization associated with mild traumatic brain injury (mTBI) in rural and urban commercially insured children.Data Source: MarketScan Commercial Claims and Encounters Data, 2007-2011.Study Design: We compared health care costs and outpatient encounters for physical/occupational therapy, speech therapy, and psychiatry/psychology encounters 180 days after mTBI among rural versus urban children (<18 years).Principal Findings: A total of 387 846 children had mTBI, with 13 percent residing in rural areas. Adjusted mean total health care costs in the 180 days after mTBI were $2778 (95% CI: 2660-2897) among rural children, compared to $2499 (95% CI: 2471-2528) among urban children (adjusted cost ratio 1.11, 95% CI 1.06-1.16). Rural-urban differences in utilization for specific services were also found.Conclusions: Total health care costs were higher for rural compared to urban children despite lower utilization of certain services. Differences in health service utilization may exacerbate geographic disparities in adverse outcomes associated with mTBI. [ABSTRACT FROM AUTHOR]

The article presents a study that focuses on functional outcomes during inpatient rehabilitation for American Indian and Alaska Native (AI/AN) children with traumatic brain injury. It mentions that AI/AN race was not associated with motor. It mentions that the providers should not assume AI/ANs with more severe injuries have equitable outcome.