Authors examine Unmet Mental Health Need Among Children with Special Health Care Needs

December 17, 2007

"Although perceived need for mental health treatment was greatest among CSHCN [children with special health care needs] with a chronic EBDP [emotional, behavioral, or developmental problem], mental health needs were also reported for 9 [percent] of [U.S.] children with chronic medical conditions that are not emotional or behavioral in nature,"
state the authors of an article published in the November-December 2007 issue of Ambulatory Pediatrics. The article describes rates of need among a national sample of CSHCN, distinguishing children with chronic EBDPs from children with primarily medical chronic conditions. The authors specifically examine whether race and ethnicity and language are associated with unmet need for the child and family members who have a
mental health need attributed to the child's special health care needs. Additional possible factors associated with unmet need for children and family members are also explored.

Data for the study were drawn from the National Survey of Children with Special Health Care Needs, which included a sample of 38,866 CSHCN (ages 17 and younger) and provided information about functional limitations, impact of the condition on the family, sociodemographics, health insurance, and access to care. Dependent variables included parental report of (1) the child's need for mental health treatment or counseling, (2) family member need for treatment or counseling resulting from the child's special health care needs, (3) the child's unmet need for mental health services, and (4) family members' unmet need for mental health services. Covariates included health condition characteristics (type, impact, and stability of the child's condition), sociodemographics (gender, family income, maternal education), presence and type of health insurance, and medical home characteristics (having a usual source of care and a regular clinician). The analysis examined
rates of need and unmet need for children and family members overall and by presence of an EBDP.

The authors found that:

Having a higher-impact condition and experiencing family burden were
each associated with greater mental health need.
Race and ethnicity were associated with need only among children with
a chronic EBDP.
In a multivariate analysis of unmet need, greater condition impact,
lower household income, and lacking insurance were each associated with
higher odds of unmet need for CSHCN both with and without a chronic EBDP.
Unmet need was greatest for CSHCN who lack both a usual source of care
and a personal doctor or nurse.

"Our study shows that unmet need for mental health treatment [or]
counseling is greatest among CSHCN with chronic emotional, behavioral
and developmental problems but also affects children with primarily
medical chronic conditions and family members of CSHCN," state the
authors. They add that "underserved populations, as indicated by greater
parental perception of unmet need, include African-American CSHCN and
family members of Hispanic children with potential limited English
proficiency."

Citation:

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. Abstract available here.

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