Associations Between Dependent-Related Job Lock And Adult Mental And Physical Health.

Dr Van Cleave's current address is Department of Pediatrics, Center for Child and Adolescent Health Policy, MassGeneral Hospital for Children, 50 Staniford St, Room 901, Boston, MA 02114. The association between bullying, being bullied, or being a bully/victim and having a special health care need has not been well described in a national sample of children with a broad variety of special needs. We aimed to determine the prevalence of bullying, being bullied, or being a bully/victim in children with special health care needs and associations of behaviors with particular types of special needs. We performed a secondary data analysis using the National Survey of Children's Health, a nationally representative telephone survey conducted by the National Center for Health Statistics of >102,000 US households. We measured associations between having a special health care need and being a victim of bullying, bullying other children, and being a bully/victim in children and adolescents aged 6 to 17 years. Multiple logistic-regression models were used to examine the association of children with special health care needs overall, and of particular special needs, with the bullying measures. Overall, children with special health care needs were 21% of the population. In multivariate models adjusting for sociodemographic factors, being a child with special health care needs was associated with being bullied but not with bullying or being a bully/victim. Having a chronic behavioral, emotional, or developmental problem was associated with bullying others and with being a bully/victim. Having a special health care need generally is associated with being bullied, and having a behavioral, emotional, or developmental problem is associated with bullying others and being a bully/victim. These findings may help pediatricians, mental health providers, and schools use targeted screening and interventions to address bullying for children with special health care needs.

* Abbreviations: ACA — : Affordable Care Act COVID-19 — : coronavirus disease ESI — : employer-sponsored insurance FPL — : federal poverty level In addition to the devastating health effects of the coronavirus disease (COVID-19) pandemic, the United States is experiencing the highest rates of unemployment since the Great Depression.1 One important and overlooked consequence of unemployment is the loss of employer-sponsored insurance (ESI) coverage for children whose parents lose their jobs. It is estimated 27 million US adults will become uninsured because of unemployment and lose ESI during the pandemic.2 During the pandemic, >4 out of 10 parents with children <19 years old reported they or a family member lost a job, work hours, or work-related income, which is slightly more than for childless adults.3 Two out of 5 adults in newly unemployed households reported having obtained their health insurance coverage from that employer. More than half of US children are covered by ESI,4 including 49% of children with preexisting conditions who have special health care needs.5 For lower-income and minority families, this loss of ESI during the COVID-19 pandemic will likely intensify already existing health disparities for children. Unemployment during the pandemic has differentially affected low-income and minority populations in the US. Children of low-wage workers are at risk for resulting coverage loss, including the 25% of children from families with incomes <138% of the federal poverty level (FPL) … Address correspondence to Lois K. Lee, MD, MPH, Division of Emergency Medicine, 300 Longwood Ave, Boston Children’s Hospital, Boston, MA 02115. E-mail: lois.lee{at}childrens.harvard.edu

This study examined the relationship of community-level stressors to behavioral and emotional problems among African-American and white children with special health care needs. The authors interviewed 257 low-income caregivers of children with special health care needs in an urban Midwestern city who brought their child for a primary health care visit to a community health center between September 2001 and May 2002. Sociodemographic characteristics as well as information about the children's behavioral and emotional problems, the health status of the children, perceptions of urban community stress, access to health care, and satisfaction with health care were collected to determine racial differences in the impact of urban stress on behavioral and emotional problems. Urban community stressors, race, and child's health status were significantly associated with behavioral and emotional problems among children with special health care needs. The association between urban stress and total behavioral problems did not differ by race. When caring for children with special health care needs, especially those with emotional or behavioral problems, primary care providers may be better able to identify important aggravating factors if they also assess urban stress. Systems of care are needed that can assist in addressing urban community-level stressors.

We sought to examine the health care experiences of children with autism spectrum disorder and the impact of autism spectrum disorder on the family and to assess whether having a medical home is associated with less family impact. We used the 2005-2006 National Survey of Children With Special Health Care Needs to compare 2088 children with special health care needs, aged 3 to 17 years, reported by their parents to have autism spectrum disorder, with children with special health care needs with "other emotional, developmental, or behavioral problems" (excluding autism spectrum disorder; n=9534) and 26751 other children with special health care needs. We used weighted logistic regression to examine unmet needs for specific health care and support services, delayed care, no usual care source or personal physician, difficulty receiving referrals, and financial, employment, or time problems because of child's care. Nationally, an estimated 535000 children have special health care needs and autism spectrum disorder, a prevalence of 86 per 10000 children aged 3 to 17 years. Among children with special health care needs, 5.6% have autism spectrum disorder. Compared with other children with special health care needs without emotional, developmental, or behavioral problems, children with special health care needs with autism spectrum disorder were more likely to have unmet needs for specific health care services, family support services, delayed or foregone care, difficulty receiving referrals, and care that is not family centered. Children with special health care needs with autism spectrum disorder were more likely to live in families that report financial problems, need additional income for the child's medical care, reduce or stop work because of the child's condition, spend >or=10 hours per week providing or coordinating care, and paid more than $1000 in the previous year for the child's care. The financial impacts of autism spectrum disorder were significantly more burdensome when children with special health care needs did not have a medical home. Children with special health care needs with autism spectrum disorder are significantly more likely to have problems regarding access to care and unmet needs, and their families have greater financial, employment, and time burdens compared with other children with special health care needs. Receipt of primary care in a medical home may reduce these burdens.

We assessed associations between parenting a child with autism and stress indicators. In the 2003 National Survey of Children's Health, parents or other knowledgeable adult respondents for children aged 4 to 17 years reported their recent feelings about their life sacrifices to care for their child, difficulty caring for their child, frustration with their child's actions, and anger toward their child. Responses were compiled in the Aggravation in Parenting Scale. Parents of children reported to have autism (N = 459) were compared with parents of: (1) children with special health care needs including emotional, developmental, or behavioral problems other than autism that necessitated treatment (children with other developmental problems [N = 4545]); (2) children with special health care needs without developmental problems (N = 11475); and (3) children without special health care needs (N = 61826). Weighted estimates are presented. Parents of children with autism were more likely to score in the high aggravation range (55%) than parents of children with developmental problems other than autism (44%), parents of children with special health care needs without developmental problems (12%), and parents of children without special health care needs (11%). However, within the autism group, the proportion of parents with high aggravation was 66% for those whose child recently needed special services and 28% for those whose child did not. The parents of children with autism and recent special service needs were substantially more likely to have high aggravation than parents of children with recent special service needs in each of the 3 comparison groups. Conversely, parents of children with autism but without recent special service needs were not more likely to have high aggravation than parents of children with other developmental problems. Parenting a child with autism with recent special service needs seems to be associated with unique stresses.

Research ObjectiveThe Supplemental Nutrition Assistance Program (SNAP) has been found to reduce food hardships, which are associated with poor health and health care outcomes among children. Evidence that SNAP improves adult health and healthcare outcomes is growing, but studies including children have been limited. The need to assess these potential relationships among children with special health care needs (SHCN) is particularly pronounced, given their heightened social and health care complexity. We therefore aimed to (i) examine relationships between SNAP, food hardships, health status, and health care use among children, and (ii) examine whether SHCN status modified any of these relationships.Study DesignTo estimate the relationship between SNAP and food hardships, we followed prior studies in using a bivariate probit model with state‐level SNAP administrative policies as instruments (to account for disproportionate self‐selection into SNAP among households with high food hardships). We estimated this model within a structural equation modeling framework to simultaneously estimate downstream associations with health status and health care use. Household food insufficiency (FI) and excellent health status (versus very good, good, fair, or poor; a robust dichotomization among children) were modeled as mediators of the relationship between any SNAP receipt and any emergency department (ED) use over the prior year. We interacted SHCN status with SNAP to assess modification, and we adjusted for sociodemographic and environmental variables (e.g., exposure to smoking). Associations were estimated as the combination of direct and indirect effects. Predicted probabilities were calculated for interpretability.Population StudiedUsing pooled 2016, 2017, and 2018 National Survey of Children's Health data (nationally representative), we examined 17,791 children in households with income below 150% of the federal poverty level (a cutoff used in prior studies), 4710 of whom had SHCN based on a validated instrument.Principal FindingsSNAP was associated with: decreased FI likelihood, increased excellent health status likelihood, and decreased ED use likelihood; SHCN status was associated with an increase in the magnitude of each of these relationships. All associations had p‐values ≤0.001. See table: FI Excellent Health Status ED Use Total No SHCN SHCN Total No SHCN SHCN Total No SHCN SHCN No SNAP 65% 63% 73% 46% 54% 22% 35% 29% 53% SNAP 32% 31% 35% 66% 74% 45% 21% 16% 33% Δ −33 −32 −37 +20 +20 +22 −14 −13 −19 ΔΔ −5 +3 −7 Δ: difference in percentage points (pp), SNAP vs. no SNAP ΔΔ: difference‐in‐difference in pp; (SNAP vs. no SNAP if SHCN) vs. (SNAP vs. no SNAP if no SHCN) ConclusionsSNAP was associated with significant beneficial effects regarding a child's likelihood of experiencing FI, excellent health status, and ED use, with even more beneficial effects found for children with SHCN.Implications for Policy or PracticeThough an incomplete solution, SNAP may improve child health and healthcare outcomes, particularly for children with elevated vulnerabilities. Greater investments in food hardship relief by healthcare systems (e.g., SNAP enrollment assistance, food Rx programs) and policymakers (e.g., increased SNAP benefits, reduced enrollment barriers) may pay substantial dividends in improved outcomes for these populations and the health systems providing them care.Primary Funding SourceNational Institutes of Health.

Medically Fragile Children Challenge Medical Home Concept

Health Care Disparities of Children and Youth: A Pediatric Nursing Concern

The medical home is a primary care model that offers comprehensive, uninterrupted, and family-centered care to children regardless of their special health care needs. Although the overall contribution of medical home is well-studied, the differential influence of its components on health care utilization and unmet needs, particularly for children and youth with special health care needs (CYSHCN) remains insufficiently understood. This study examined the medical home component(s) that can best predict emergency and preventive visits, and unmet needs in CYSHCN. This study analyzed 2016-2022 National Survey of Children's Health data from 64553 caregivers of CYSHCN aged 0-17years using the Rao-Scott Chi-square test and multivariable logistic regression. Findings show that receiving care within an overall medical home was associated with lower odds of emergency visits [adjusted odds ratio (aOR): 0.77 (95% confidence interval: 0.70-0.84)] and unmet needs [aOR = 0.29 (0.24-0.34)], and higher odds of preventive dental visits [aOR = 1.40 (1.25-1.57)]. Having a usual source for sick care and receiving effective care coordination was associated with reduced odds of emergency visits (aOR = 0.74 [0.64-0.84] and aOR = 0.85 [0.77-0.95], respectively). Receiving family-centered care [aOR = 0.45 (0.38-0.54)], no problems getting needed referral [aOR = 0.58 (0.47-0.72)], and getting effective care coordination when needed [aOR = 0.32 (0.26-0.39)] were associated with lower odds of unmet needs. The odds of utilizing preventive medical and dental visits was higher with having a personal doctor or nurse [aOR = 1.42(1.12-1.80) and aOR = 1.41 (1.20-1.65), respectively] and receiving family-centered care [aOR = 1.59 (1.18-2.12) and aOR = 1.44 (1.22-1.71), respectively]. The study highlights the importance of considering the differential contribution of medical home components for reducing emergency visits, addressing unmet needs, and improving preventive care, providing insights to enhance health care delivery for CYSHCN.

Challenges Facing Pediatric Nursing

The purpose of this work was to determine whether children with special health care needs in New Jersey's State Children's Health Insurance Program are less likely to become uninsured than children without special health care needs. We used the 2003 New Jersey FamilyCare Supplement to the New Jersey Family Health Survey. Children were randomly selected from the universe of children enrolled in New Jersey FamilyCare as of May 2002, and their families were surveyed during 2003 (N = 675). The Children With Special Health Care Needs Screener was used to identify 5 types of special health care needs. We estimated multinomial logistic regression models of final enrollment status according to the presence of > or = 1 special health care need, controlling for demographic characteristics. Roughly 1 of every 5 children in New Jersey FamilyCare had > or = 1 special health care need. Older children and boys had greater odds of having special health care needs than others. Children with special health care needs had only one fourth the odds of becoming disenrolled and uninsured compared with children without special health care needs, even when controlling for age, gender, race/ethnicity, and insurance plan level. There was no difference in likelihood of finding other health insurance according to children with special health care needs status. Children with special health care needs were more likely than children without such needs to be covered by health insurance at the time of the survey, either by retaining State Children's Health Insurance Program coverage or by finding other insurance. The higher retention of children with special health care needs in New Jersey FamilyCare is good news for families of these children and their advocates. However, higher health care costs for these children should be considered in federal and state budget planning for the State Children's Health Insurance Program.

Association Between Sexual Orientation and Gender Identity Discrimination and Youth Physical Health: Findings From a Nationally Representative Sample.

Medicaid managed care plans cover more than 80percent of Medicaid-enrolled children, including many children with special health care needs (CSHCN). Federal rules require states to set network adequacy standards to improve specialty care access for Medicaid managed care enrollees. Using a quasi-experimental design and 2016-19 National Survey of Children's Health data, we examined the association between quantitative network adequacy standards and access to specialty care among 8,614 Medicaid-enrolled children, including 3,157 with special health care needs, in eighteen states. Outcomes included whether the child had any visit to non-mental health specialists, any visit to mental health professionals, or any unmet health care needs and whether the caregiver ever felt frustrated in getting services for the child in the past year. We observed no association between the adoption of any quantitative network adequacy standard and the above outcomes among Medicaid-enrolled children. Among CSHCN, however, adopting any quantitative standard was positively associated with caregivers feeling frustrated in getting services for the child, especially among CSHCN who visited non-mental health specialists. Without additional interventions, adopting new network adequacy standards may have unintended consequences for CSHCN.

Caregivers of children with special health care needs (CSHCN) experience substantial strain caring for their child's special needs because of high needs for health and other support services. Caregivers of CSHCN with emotional, behavioral, or developmental problems (EBDPs) report stress and poor mental health at higher rates than caregivers of other CSHCN. Although family support services are associated with caregiver mental health and well-being among families of CSHCN, the association of these factors with caregiver coping has been underexamined. Using the Double ABCX Model of Family Adaptation to guide variable selection, this study uses 2016 to 2019 data from the National Survey of Children's Health. Univariate, bivariate, and multivariate logistic analyses examined the association between caregivers' receipt of adequate care coordination and emotional support services and their reported coping with the day-to-day strains of parenting. These relationships are compared between caregivers of CSHCN with and without EBDPs. Receipt of adequate care coordination was associated with higher rates of caregiver-reported positive coping for all caregivers of CSHCN who have no source of emotional support. Receipt of emotional support services was associated with increased reports of positive coping for caregivers for all CSHCN as well. Caregivers reporting only informal sources of emotional support, however, also reported higher rates of positive coping when compared with caregivers with no source of emotional support. Mobilization of resources that can aid caregivers in coordinating care and provide emotional support may play a key role in positive caregiver coping for families of CSHCN.

Academic pediatric departments, government agencies, and children with special health care needs