Abstract
Drawing upon the National Survey of Children with Special Healthcare Needs (2009/2010), multilevel logistic regression analysis assessed the relationship between parent report of a youth having an emotional, behavioral, or developmental problem (EBDP), their level of reported functional limitations, and parents’ report of unmet mental health care needs and experience with cost-barriers to accessing needed healthcare services. Results indicate that, compared to all privately insured youth with special health care needs, parents of privately insured youth with EBDP are much more likely to report their child having unmet mental health care needs (OR 12.16; p < 0.001) and experiencing cost barriers to care (OR 2.37; p < 0.001). Parents of privately insured youth with EBDP with functional limitations are even more likely to report these concerns (Unmet Mental Health Needs: OR 17.09; p < 0.001; Cost Barriers: OR 5.77; p < 0.001). However, findings suggest that having public insurance is associated with reductions in the odds of having unmet needs for youth with SED by 50%. Public insurance and dual coverage is associated with reductions in the odds of encountering cost barriers to care by almost 50% for children with EBDP, and by more 50% for youth with EBDP and functional impairments.
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References
Barth, R., Greenson, J., Guo, S., Green, R., & Sisson, J. (2007). Outcomes for youth receiving intensive in-home therapy or residential care: A comparison using propensity scores. American Journal of Orthopsychiatry,77(4), 497–505. https://doi.org/10.1037/0002-9432.77.4.497.
Beckles, G. L. A., Williamson, D. F., Brown, A. F., Gregg, E. W., Karter, A. J., Kim, C., et al. (2007). Agreement between self-reports and medical records was only fair in a cross-sectional study of performance of annual eye examinations among adults with diabetes in managed care. Medical Care,45(9), 876–883. https://doi.org/10.1097/MLR.0b013e3180ca95fa.
Blackman, J. A., Gurka, M. J., Gurka, K. K., & Oliver, M. N. (2011). Emotional, developmental and behavioural co-morbidities of children with chronic health conditions. Journal of Paediatrics and Child Health,47(10), 742–747. https://doi.org/10.1111/j.1440-1754.2011.02044.x.
Boyle, C. A., Boulet, S., Schieve, L. A., Cohen, R. A., Blumberg, S. J., Yeargin-Allsopp, M., et al. (2011). Trends in the prevalence of developmental disabilities in US children, 1997–2008. Pediatrics,127(6), 1034–1042. https://doi.org/10.1542/peds.2010-2989.
Bramlett, M. D., Read, D., Bethell, C., & Blumberg, S. J. (2009). Differentiating subgroups of children with special health care needs by health status and complexity of health care needs. Maternal and Child Health Journal,13(2), 151–163. https://doi.org/10.1007/s10995-008-0339-z.
Bringewatt, E. H., & Gershoff, E. T. (2010). Falling through the cracks: Gaps and barriers in the mental health system for America’s disadvantaged children. Children and Youth Services Review,32(10), 1291–1299. https://doi.org/10.1016/j.childyouth.2010.04.021.
Buis, M. L. (2010). Stata Tip 87: Interpretation of interactions in nonlinear models. The Stata Journal,10(2), 305–308. https://doi.org/10.1177/1536867X1001000211.
Busch, S. H., & Barry, C. L. (2009). Does private insurance adequately protect families of children with mental health disorders? Pediatrics,124(Suppl 4), S399–S406. https://doi.org/10.1542/peds.2009-1255K.
Chavira, D. A., Garland, A. F., Daley, S., & Hough, R. (2008). The impact of medical comorbidity on mental health and functional health outcomes among children with anxiety disorders. Journal of Developmental and Behavioral Pediatrics: JDBP,29(5), 394–402. https://doi.org/10.1097/DBP.0b013e3181836a5b.
Cook, B. L., Doksum, T., Chen, C.-N., Carle, A., & Alegría, M. (2013). The role of provider supply and organization in reducing racial/ethnic disparities in mental health care in the U.S. Social Science and Medicine, 84, 102–109. https://doi.org/10.1016/j.socscimed.2013.02.006.
Combs-Orme, T., Heflinger, C. A., & Simpkins, C. G. (2002). Comorbidity of mental health problems and chronic health conditions in children. Journal of Emotional and Behavioral Disorders,10(2), 116–125. https://doi.org/10.1177/10634266020100020601.
Costello, E. J., He, J., Sampson, N. A., Kessler, R. C., & Merikangas, K. R. (2014). Services for adolescents with psychiatric disorders: 12-month data from the National Comorbidity Survey-Adolescent. Psychiatric Services (Washington, D.C.),65(3), 359–366. https://doi.org/10.1176/appi.ps.201100518.
Derigne, L., Porterfield, S., & Metz, S. (2009). The influence of health insurance on parent’s reports of children’s unmet mental health needs. Maternal and Child Health Journal,13(2), 176–186. https://doi.org/10.1007/s10995-008-0346-0.
Friedman, S. L., Norwood, K. W., & Disabilities, C. on C. W. (2016). Out-of-home placement for children and adolescents with disabilities—addendum: Care options for children and adolescents with disabilities and medical complexity. Pediatrics,138(6), e20163216. https://doi.org/10.1542/peds.2016-3216.
Friesen, B. J., Giliberti, M., Katz-Leavy, J., Osher, T., & Pullmann, M. D. (2003). Research in the service of policy change: The “Custody Problem”. Journal of Emotional and Behavioral Disorders,11(1), 39–47. https://doi.org/10.1177/106342660301100106.
Gelberg, L., Andersen, R. M., & Leake, B. D. (2000). The behavioral model for vulnerable populations: Application to medical care use and outcomes for homeless people. Health Services Research,34(6), 1273–1302.
Glassgow, A. E., & Voorhees, B. V. (2017). Behavioral health disparities among children and youth with special health care needs. Pediatric Annals,46(10), e382–e386. https://doi.org/10.3928/19382359-20170920-02.
Graaf, G., & Snowden, L. (2017). The role of Medicaid home and community-based service policies in organizing and financing care for children with severe emotional disturbance. Children and Youth Services Review,81, 272–283. https://doi.org/10.1016/j.childyouth.2017.08.007.
Graaf, G., & Snowden, L. (2019). State approaches to funding home and community-based mental health care for non-Medicaid youth: Alternatives to Medicaid waivers. Administration and Policy in Mental Health and Mental Health Services Research. https://doi.org/10.1007/s10488-019-00933-2.
Grape, A., Meeker, E., & Fielding, S. L. (2013). Service pathways for children and youth meeting criteria for serious emotional disturbance. Social Work in Mental Health,11(6), 497–515. https://doi.org/10.1080/15332985.2013.801389.
Greenbaum, P. E., Dedrick, R. F., Friedman, R. M., Kutash, K., Brown, E. C., Lardieri, S. P., et al. (1996). National Adolescent and Child Treatment Study (NACTS): Outcomes for children with serious emotional and behavioral disturbance. Journal of Emotional and Behavioral Disorders,4(3), 130–146. https://doi.org/10.1177/106342669600400301.
Hansen, M., Litzelman, A., Marsh, D. T., & Milspaw, A. (2004). Approaches to serious emotional disturbance: Involving multiple systems. Professional Psychology: Research and Practice,35(5), 457–465. https://doi.org/10.1037/0735-7028.35.5.457.
Hill, K. (2017). Prevalence, experiences, and characteristics of children and youth who enter foster care through voluntary placement agreements. Children and Youth Services Review,74, 62–70. https://doi.org/10.1016/j.childyouth.2017.01.025.
Holgash, K., & Heberlein, M. (2019). Physician acceptance of new medicaid patients: What matters and what doesn’t| health affairs. Retrieved August 21, 2019, from https://www.healthaffairs.org/do/10.1377/hblog20190401.678690/full/#.XVwyNWJg5ZM.email.
Howell, E. M. (2004). Access to Children’s Mental Health Services under Medicaid and SCHIP. Retrieved from The Urban Institute from http://webarchive.urban.org/publications/311053.html.
Inkelas, M., Raghavan, R., Larson, K., Kuo, A. A., & Ortega, A. N. (2007). Unmet mental health need and access to services for children with special health care needs and their families. Ambulatory Pediatrics,7(6), 431–438. https://doi.org/10.1016/j.ambp.2007.08.001.
Kernan, J. B., Griswold, K. S., & Wagner, C. M. (2003). Seriously emotionally disturbed youth: A needs assessment. Community Mental Health Journal,39(6), 475–486. https://doi.org/10.1023/B:COMH.0000003009.21130.da.
Kessler, R. C., Avenevoli, S., Costello, J., Green, J. G., Gruber, M. J., McLaughlin, K. A., et al. (2012). Severity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication Adolescent Supplement. Archives of General Psychiatry,69(4), 381–389. https://doi.org/10.1001/archgenpsychiatry.2011.1603.
Marcenko, M. O., Keller, T. E., & Delaney, M. A. (2001). Children with SED and their families in an urban public mental health system: Characteristics, needs, and expectations. Journal of Child and Family Studies,10(2), 213–226.
Mark, T. L., & Buck, J. A. (2006). Characteristics of U.S. youths with serious emotional disturbance: Data from the National Health Interview Survey. Psychiatric Services,57(11), 1573–1578. https://doi.org/10.1176/appi.ps.57.11.1573.
McPherson, M., Arango, P., Fox, H., Lauver, C., McManus, M., Newacheck, P. W., et al. (1998). A new definition of children with special health care needs. Pediatrics,102(1 Pt 1), 137–140. https://doi.org/10.1542/peds.102.1.137.
Merikangas, K. R., He, J.-P., Brody, D., Fisher, P. W., Bourdon, K., & Koretz, D. S. (2010). Prevalence and treatment of mental disorders among US children in the 2001–2004 NHANES. Pediatrics,125(1), 75–81. https://doi.org/10.1542/peds.2008-2598.
Miller, K. (2014). Care coordination impacts on access to care for children with special health care needs enrolled in Medicaid and CHIP. Maternal and Child Health Journal,18(4), 864–872. https://doi.org/10.1007/s10995-013-1312-z.
Miller, R., Tumin, D., Hayes, D., Uffman, J. C., Raman, V. T., & Tobias, J. D. (2018). Unmet need for care coordination among children with special health care needs. Population Health Management. https://doi.org/10.1089/pop.2018.0094.
Nageswaran, S., Parish, S. L., Rose, R. A., & Grady, M. D. (2011). Do children with developmental disabilities and mental health conditions have greater difficulty using health services than children with physical disorders? Maternal and Child Health Journal,15(5), 634–641. https://doi.org/10.1007/s10995-010-0597-4.
Ng, T., Stone, J., & Harrington, C. (2015). Medicaid home and community-based services: How consumer access is restricted by state policies. Journal of Aging and Social Policy, 27(1), 21–46. https://doi.org/10.1080/08959420.2015.969078of.
Owens, P., Hoagwood, K., Horwitz, S. M., Leaf, P. J., Poduska, J., Kellam, S. G., et al. (2002). Barriers to children’s mental health services. Journal of the American Academy of Child and Adolescent Psychiatry,41(6), 731–738. https://doi.org/10.1097/00004583-200206000-00013.
Palmer, L., Johnston, S. S., Rousculp, M. D., Chu, B.-C., Nichol, K. L., & Mahadevia, P. J. (2012). Agreement between Internet-based self- and proxy-reported health care resource utilization and administrative health care claims. Value in Health: The Journal of the International Society for Pharmacoeconomics and Outcomes Research,15(3), 458–465. https://doi.org/10.1016/j.jval.2011.12.015.
Pires, S. A., Grimes, K. E., Allen, Gilmer, T., & Mahadevan, R. (2013). Faces of Medicaid: Examining Children’s Behavioral Health Service Use and Expenditures. Retrieved from Center for Health Care Strategies http://www.chcs.org/.
Popescu, I., Xu, H., Krivelyova, A., & Ettner, S. L. (2015). Disparities in receipt of specialty services among children with mental health need enrolled in the CMHI. Psychiatric Services,66(3), 242–248. https://doi.org/10.1176/appi.ps.201300055.
Ringel, J. S., & Sturm, R. (2001). National estimates of mental health utilization and expenditures for children in 1998. The Journal of Behavioral Health Services and Research, 28(3), 319–333. https://doi.org/10.1007/BF02287247.
Sheppard, R., Deane, F. P., & Ciarrochi, J. (2017). Unmet need for professional mental health care among adolescents with high psychological distress. Australian and New Zealand Journal of Psychiatry. https://doi.org/10.1177/0004867417707818.
Shepperd, S., Doll, H., Gowers, S., James, A., Fazel, M., Fitzpatrick, R., et al. (2009). Alternatives to inpatient mental health care for children and young people. The Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd006410.pub2.
Short, M. E., Goetzel, R. Z., Pei, X., Tabrizi, M. J., Ozminkowski, R. J., Gibson, T. B., et al. (2009). How accurate are self-reports? An analysis of self-reported healthcare utilization and absence when compared to administrative data. Journal of Occupational and Environmental Medicine/American College of Occupational and Environmental Medicine,51(7), 786–796. https://doi.org/10.1097/JOM.0b013e3181a86671.
Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: Prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child and Adolescent Psychiatry,47(8), 921–929. https://doi.org/10.1097/CHI.0b013e318179964f.
Snowden, L. R., Masland, M., Wallace, N., Fawley-King, K., & Cuellar, A. E. (2008). Increasing California children’s Medicaid-financed mental health treatment by vigorously implementing Medicaid’s Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Program. Medical Care, 46(6), 558–564. https://doi.org/10.1097/MLR.0b013e3181648e82.
Snyder, A., Marton, J., McLaren, S., Feng, B., & Zhou, M. (2017). Do high fidelity wraparound services for youth with serious emotional disturbances save money in the long-term? The Journal of Mental Health Policy and Economics,20(4), 167–175.
Stiffman, A. R., Hadley-Ives, E., Doré, P., Polgar, M., Horvath, V. E., Striley, C., et al. (2000). Youths’ access to mental health services: The role of providers’ training, resource connectivity, and assessment of need. Mental Health Services Research,2(3), 141–154. https://doi.org/10.1023/A:1010189710028.
Stroul, B. A. (1993). Systems of care for children and adolescents with severe emotional disturbances: What are the results? Retrieved from http://eric.ed.gov/?id=ED364025.
Substance Abuse and Mental Health Services Administration, & Center for Mental Health Services. Definition of children with a serious emotional disturbance., Pub. L. No. 29425, 96 58 (1993).
Thomas, K. C., Williams, C. S., deJong, N., & Morrissey, J. P. (2016). Examination of parent insurance ratings, child expenditures, and financial burden among children with autism: A mismatch suggests new hypotheses to test. Pediatrics,137(Supplement 2), S186–S195. https://doi.org/10.1542/peds.2015-2851Q.
Urdapilleta, O., Kim, G., Wang, Y., Howard, J., Varghese, R., Waterman, G., … Palmisano, C. (2013). National evaluation of the medicaid demonstration waiver home- and community-based alternatives to psychiatric residential treatment facilities. Retrieved from Submitted to Disabled and Elderly Health Programs Group Centers for Medicare and Medicaid Services, Contract Number: HHSM-500-2006-00007I, Task Order #2 Final Evaluation Report. IMPAQ Interntional, Inc http://www.bazelon.org/News-Publications/Publications/List/1/CategoryID/20/Level/a.aspx?SortField=ProductNumber%2cProductNumber.
Varda, D. M., Hardy, R., & Talmi A. M. and A. (2016). Public health, mental health and primary care differences in urban and rural counties in a system of care for children with special healthcare needs. Health Systems and Policy Research. Retrieved from http://www.hsprj.com/abstract/public-health-mental-health-and-primaryrncare-differences-in-urban-and-rural-countiesrnin-a-system-of-care-for-children-with-specialrnhealthcare-needs-11194.html
Walker, E. R., Cummings, J. R., Hockenberry, J. M., & Druss, B. G. (2015). Insurance status, use of mental health services, and unmet need for mental health care in the united states. Psychiatric Services,66(6), 578–584. https://doi.org/10.1176/appi.ps.201400248.
Williams, N. J., Scott, L., & Aarons, G. A. (2017). Prevalence of serious emotional disturbance among U.S. children: A meta-analysis. Psychiatric Services. https://doi.org/10.1176/appi.ps.201700145.
Wilson, K., Hirschi, M., Comeau, M., Bronheim, S., & Bachman, S. S. (2014). Disparities in insurance coverage among children with special health care needs: How social workers can promote social and economic justice. Health and Social Work,39(2), 121–127.
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Graaf, G., Snowden, L. Public Health Coverage and Access to Mental Health Care for Youth with Complex Behavioral Healthcare Needs. Adm Policy Ment Health 47, 395–409 (2020). https://doi.org/10.1007/s10488-019-00995-2
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DOI: https://doi.org/10.1007/s10488-019-00995-2