Employment change and the role of the medical home for married and single-mother families with children with special health care needs

doi:10.1016/j.socscimed.2009.10.054

Social Science & Medicine

Volume 70, Issue 4, February 2010, Pages 631-641

https://doi.org/10.1016/j.socscimed.2009.10.054 Get rights and content

Abstract

One in five U.S. households with children has at least one child with a special health care need (USDHHS, 2004). Like most parents, those with children with special health care needs struggle to balance child-rearing responsibilities with employment demands. This research examines factors affecting married parents' and single-mother's employment change decisions focusing specifically on whether having a medical home influences these decisions. This study includes 38,569 children with special health care needs from birth through age 17 surveyed in the 2005–2006 National Survey of Children with Special Health Care Needs. The employment model is estimated using multinomial logistic regression with the choice of a parent to maintain their current level of employment, reduce work hours, or stop working as the dependent variable. Independent variables are those characterizing the needs of the child, the resources of the family, and the socio-demographic characteristics of the family. Components of the medical home variable include: 1) having a usual source of care; 2) care provided is “family centered”; 3) receipt of care coordination services; and 4) receipt of needed referrals. Half of the children in our sample met criteria in all four facets. If the child has a medical home, the relative risk of a parent choosing to cut hours rather than not change hours decreases by 51%. The relative risk of choosing to stop working rather than not change hours decreases by an estimated 64%. Care coordination services significantly reduce the odds of changing employment status. Our results suggest that the medical home is a moderating factor in parental decisions concerning change in employment status.

Section snippets

Medical home

The concept of a medical home is not a new one. It was originally laid out by the American Academy of Pediatrics in 1967 as a method for improving the care of children with special needs (Backer, 2007). The AAP in 2002 published a definition of a medical home as care that is accessible, family centered, coordinated, comprehensive, continuous, compassionate, and culturally effective.

Although there is much discussion of the role of the medical home in both academic literature and the popular

Employment levels of parents

Research has generally found that parents of children with disabilities have lower levels of employment than parents of typically developing children. This research has focused primarily on mothers in part because results of research on employment levels of fathers by child's disability status are mixed (Kuhlthau and Perrin, 2001, Seltzer et al., 2001). Several studies have found lower maternal employment in families with children with disabilities (Corman et al., 2005, Gordon et al., 2006,

Dataset

This study uses the 2005–2006 National Survey of Children with Special Health Care Needs (NSCSHCN) to examine factors associated with a change in employment status of parents with children with special health care needs, focusing specifically on whether having a medical home influences this choice. The NSCSHCN interviews were conducted in the U.S. from April 2005 to December 2006 as a module of the State and Local Area Integrated Telephone Survey (SLAITS) (USDHHS, 2004). Surveys were completed

Results

Table 1 suggests that single-mothers are significantly more likely to have made a change in their work hours in the past year than married parents. The characteristics of children with special health care needs are significantly different in single-mother and married households in almost all variables shown in Table 1. Yet in both family types, parents whose children have a medical home are significantly less likely to have made a change in their work hours over the past year, suggesting that

Discussion

Results from this study highlight the inordinate costs, both in time and money, associated with raising a child with special health care needs. Our employment change analysis suggests that parents choose to provide time when confronted with the time or money tradeoff, finding money for the higher out-of-pocket costs needed for these children by means other than increasing employment. This may mean spending savings or increasing debt, depending on the family's financial situation.

There appear to

Limitations

Using parents to report on their perceptions of whether or not a child received care in a medical home can be both a strength and a limitation (Mayer et al., 2004, Newacheck et al., 2000). The NSCSHCN does not provide the perspective of any other key players, especially health care providers, in measuring the extent to which CSHCN have received care in a medical home or not (Strickland et al., 2004). Although we based our operationalization of the medical home variable on previous research it

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Employment change and the role of the medical home for married and single-mother families with children with special health care needs

Abstract

Section snippets

Medical home

Employment levels of parents

Dataset

Results

Discussion

Limitations

Midwifery

Societal and individual determinants of medical care utilization in the United States

The Milbank Memorial Fund Quarterly

Effects of children with Down syndrome on parents' activities

American Journal of Mental Retardation

Employment behaviors of mothers who have a child with asthma

Journal of Family Economic Issues

Using existing population based datasets to measure the American academy of pediatrics definition of medical home for all children and children with special health care needs

Pediatrics

The economics of women, men and work

Women's labor force activity and responsibilities for disabled dependents: a study of families with disabled children

Journal of Health and Social Behavior

Mothers' labor supply in fragile families: the role of child health

Eastern Economic Journal

Constrained labour: maternal employment when children have disabilities

Journal of Applied Research in Intellectual Disabilities

Decomposing the effects of children's health on mother's labor supply: is it time or money?

Health Economics

Parental employment and health insurance coverage among school-aged children with special health care needs

American Journal of Public Health

A national profile of the health care experiences and family impact of autism spectrum disorder among children in the United States, 2005–2006

Pediatrics

Child health status and parental employment

Archives of Pediatric and Adolescent Medicine

The consequences of caring: effects of mothering a child with special needs

Journal of Family Issues