Nontraditional Family Structures Research Articles

Family resilience and caregiver's well-being across different age groups of children with ADHD in the United States: a cross-sectional study.

This study aimed to investigate the impact of family resilience on caregiver well-being across various age groups of children diagnosed with ADHD (attention-deficit/hyperactivity disorder) groups (0-5, 6-11, and 12-17 years). Utilizing secondary data from the 2022 US National Survey of Child Health, this cross-sectional study involved 2,752 children who were formally diagnosed with ADHD. Statistical analysis included descriptive analysis, Spearman's rank correlation, chi-square tests, and linear regression, conducted using SPSS version 27. The study revealed a moderate positive correlation (r=.35, p<.001) between family resilience and caregiver well-being. Controlling for covariates, family resilience accounted for 25.2%, 21.1%, and 22.1% of caregiver well-being variance in age groups 0-5, 6-11, and 12-17 years, respectively. Additionally, factors like employment status, family structure, and caregiver age showed varying influences on caregiver well-being across these developmental stages. A consistent pattern emerged across these age groups: unemployment and non-traditional family structures were associated with negative impacts on caregiver well-being, whereas older caregiver age positively influenced well-being. This research underscores the importance of age-specific family resilience strategies to improve caregiver well-being and family interactions in ADHD contexts. Investigating these aspects through qualitative studies across various cultures could deepen our understanding of well-being and inform culturally sensitive interventions.

The Role of Family Structure in Juvenile Delinquency

Purpose: The general purpose of the study was to explore the role of family structure and juvenile diplomacy. Methodology: The study adopted a desktop research methodology. Desk research refers to secondary data or that which can be collected without fieldwork. Desk research is basically involved in collecting data from existing resources hence it is often considered a low cost technique as compared to field research, as the main cost is involved in executive’s time, telephone charges and directories. Thus, the study relied on already published studies, reports and statistics. This secondary data was easily accessed through the online journals and library. Findings: The findings reveal that there exists a contextual and methodological gap relating to family structure in juvenile diplomacy. Preliminary empirical review revealed that that family structure significantly influences adolescent engagement in delinquent behaviors, with adolescents from single-parent households or non-traditional family arrangements exhibiting higher rates of delinquency. Research highlighted the mediating role of factors such as parental supervision and positive peer relationships, along with cultural variations in this relationship. Qualitative insights underscored the unique challenges faced by adolescents from non-traditional family structures, emphasizing the importance of tailored support. Overall, the findings underscored the need for context-specific interventions and policies to address juvenile delinquency, informed by a comprehensive understanding of family dynamics and socio-cultural factors. Unique Contribution to Theory, Practice and Policy: Social Learning theory, Strain theory and Social Control theory may be used to anchor future studies on the role of family structure in juvenile delinquency. The study provided recommendations with significant contributions to theory, practice, and policy. It advanced theoretical understanding by highlighting the complex interplay between family dynamics and delinquent behavior, contributing empirical support for existing theoretical models. The study recommended the development of family-centered interventions to strengthen parental supervision and support networks, promote positive peer relationships, and address systemic factors contributing to family stressors. Policy implications included initiatives to support family well-being, invest in evidence-based programs, and integrate findings into broader social policies. Collaboration across sectors was emphasized to implement comprehensive approaches, and the need for continued research to deepen understanding and inform targeted interventions was underscored.

Traditional and Nontraditional Family Structures: Influence on Students’ Academic Ability, Achievement, and Readiness

The study aimed to measure the influence of traditional and nontraditional family structures on the academic ability and achievement of students in elementary, and their readiness in high school academic work. The study utilized a descriptive-correlation design which was employed to randomly select 179 students from a basic education institution in Tacurong City. The result of the study showed that there is a significant difference between the standard scores of students in traditional and nontraditional families in terms of their academic ability, achievement, and readiness. It can also be inferred that students who performed well in ability test, also performed well in achievement and readiness tests. Subsequently, those who had high achievement scores in grade six were more ready in their academic works in high school. Thus, it is necessary to increase the involvement of parents in school to monitor their children’s progress and performance. It is also integral to nurture an educational environment that supports students from diverse family structures.

Independently planned parenthood: Sexual identity and evaluations of single-parenthood-by-choice.

Parenthood is usually viewed as happening within the institution of marriage. Single parenthood has a negative connotation and is typically associated with divorce, separation, or widowhood. However, independently planned parenthood, or single-parenthood-by-choice, is intrinsically different in that independently planned parents actively plan to pursue parenthood without a romantic partner, sexual partner, or other coparenting unit. This study examined attitudes toward independently planned parenthood and willingness to consider independently planned parenthood as a function of gender and sexual identity. Participants included 631 cisgender young adults (201 lesbian/gay, 430 heterosexual) living in the United States. Women had more positive attitudes toward independently planned parenthood than men, and lesbian and gay people had more positive attitudes toward independently planned parenthood than heterosexual people. Gay men were more willing to consider becoming parents independently than heterosexual men, but there were no significant differences between lesbian and heterosexual women. In all, independently planned parents are an underrecognized population within single parenthood. These parents challenge the patriarchal and heteronormative norms surrounding parenthood and may suffer social backlash and stigmatization because of their decision to pursue parenthood alone. However, this study finds that monosexual women and gay men may be more welcoming of this nontraditional family structure than heterosexual men. This research acts as a foundation to continue to explore issues of independently planned parenthood. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Risk of new onset and persistent psychopathology in children with long-term physical health conditions: a population-based cohort study.

Children and young people (CYP) with long-term physical health conditions (pLTCs) have increased risk of psychopathology compared to physically healthier peers. We explored risk factors for new onset and persistent psychiatric disorders in CYP with pLTCs compared to CYP without pLTCs. This 3-year follow-up study involved a UK representative sample of CYP from the British Child and Adolescent Mental Health Surveys (N = 7804). We examined potential baseline predictors of new onset and persistent psychiatric disorders at follow-up in four groups of children based on the presence of any physical and/or any psychiatric conditions at baseline. Psychiatric disorders were assessed using standardised multi-informant diagnostic assessment. Separate multivariable binary logistic regressions were conducted for each group. In CYP with pLTCs, rented housing (aOR = 1.42, 95% CI 1.01 to 1.99), non-traditional family structure (aOR = 2.08, 95% CI 1.42 to 3.05), increased parental distress (aOR = 1.09, 95% CI 1.04 to 1.14), and greater peer relationship difficulties (aOR = 1.29, 95% CI 1.19 to 1.39) predicted future psychiatric disorder. Only peer relationship difficulties predicted persistent disorder (aOR = 1.27, 95% CI 1.17 to 1.38) in this group. A greater number of factors predicted the onset of psychiatric disorder in CYP with pLTCs compared to physically healthier peers and similarly, a higher number of factors predicted persistent disorder in CYP without pLTCs. CYP with pLTCs might comprise a group with different vulnerabilities, some of which are potentially tractable and may be useful indicators of patients who require preventable or management interventions.

UNPARTNERED AND CHILDLESS OLDER ADULTS' RISK OF LONELINESS DURING COVID-19 BY COUNTRY CONTEXT

Abstract Older adults with non-traditional family structures (unpartnered and childless) may be at higher risk for loneliness. Yet, experiences of loneliness during COVID-19 can vary depending on a country’s context (e.g., culture, demography, COVID-19 mitigation policies, severity of the pandemic). We explore associations between older Europeans’ family structure and loneliness to assess risks for those with non-traditional family structures (e.g., unpartnered vs partnered, childless vs parents) during the pandemic across a variety of country contexts. We analyze data from the Survey of Health, Ageing and Retirement in Europe (SHARE) collected before (2019/2020) and twice during (2020, 2021) the pandemic to examine if unpartnered and childless older adults are at higher risk of loneliness, and compare results by multiple indicators of country context (fertility and partnership rates, stringency of COVID mitigation policies, population age composition, and COVID fatality rates). Results of this study can potentially inform current and future pandemic mitigation strategies.

KINLESSNESS AND COGNITIVE FUNCTION AMONG EUROPEAN OLDER ADULTS

Abstract So-called “kinless” older adults (unpartnered and childless) are a growing population across the globe who may be at higher risk for social isolation and cognitive decline. Yet, this group of older adults is understudied in dementia-related research and their risk of cognitive decline likely varies by country context. We analyze data from the Survey of Health, Ageing &amp; Retirement in Europe (SHARE) to explore cognitive decline by family structure and country. We assess cognitive decline along a gradient of “kinlessness” by comparing older adults with a) partner and child, b) partner and no child, c) no partner and child, and d) no partner and no child across 20 European countries. Results of this study will outline the dementia risks faced by the growing population of older adults with non-traditional family structures and highlight characteristics of country context that might enhance or reduce risk of cognitive decline for “kinless” older adults.

Family Structure and Delinquency in the English-Speaking Caribbean: The Moderating Role of Parental Attachment, Supervision, and Commitment to Negative Peers

Growing up in a household without two parents present is an established risk factor for youth delinquency. However, much of the research on family structure and delinquency derives from U.S. samples, limiting applicability to the developing world. The present study explores the role of traditional and non-traditional family structures on self-reported delinquency in eight English-speaking Caribbean nations. We further examine the moderating role of family processes (parental attachment and parental supervision) and commitment to negative peers on this relationship. We find that youth from intact nuclear families, with a mother and father present, engage in less delinquency than youth from intact blended, single-parent, or no-parent households. Further, family structure moderated the relationship between delinquency, parental attachment, and commitment to negative peers. Theoretical and research implications are discussed.

Gendered Diverging Destinies: Changing Family Structures and the Reproduction of Educational Inequalities Among Sons and Daughters in the United States.

The prevalence of nontraditional family structures has increased over time, particularly among socioeconomically disadvantaged families. Because children's socioeconomic attainments are positively associated with growing up in a two-parent household, changing family structures are considered to have strengthened the reproduction of social inequalities across generations. However, several studies have shown that childhood family structure relates differently to educational outcomes for sons than for daughters. Therefore, we ask whether there are gender differences in the extent to which changing family structures have contributed to the college attainment gap between children from lower and higher socioeconomic backgrounds. We use data from the National Longitudinal Survey of Youth 1979 and 1997 cohorts to estimate extended Oaxaca-Blinder decomposition models that take into account cross-cohort changes in the prevalence of family structures and heterogeneity in the effects of childhood family structure on college attainment. We find that the argument that changes in family structures contributed to diverging destinies in college attainment holds for daughters but not for sons. This result is due to the different changes over time in the effects of childhood family structure by gender and socioeconomic background.

The role of tobacco smoking and illicit drug use in adolescent acute alcohol intoxication

BackgroundThis study aims to determine the prevalence of tobacco smoking and illicit drug use among Dutch adolescents admitted to hospital for acute alcohol intoxication treatment. Furthermore, socio-demographic predictors for smoking and illicit drug use in the sample population will be studied. The relationship between illicit drug use and specific characteristics of intoxication, such as blood alcohol concentration (BAC) and duration of reduced consciousness is also investigated.MethodsThe national Dutch Paediatric Surveillance Unit was used to prospectively register cases of acute alcohol intoxication from 2007 through 2017. Cases were included if they met the following inclusion criteria: BAC > 0.0 g/L, aged between 10 to 18 years old and requiring hospital treatment due to reduced consciousness. Questionnaires were sent to paediatricians to obtain clinical information.ResultsDuring the period 2007–2017, 5322 cases that met the inclusion criteria were reported. In this patient group, the prevalence of tobacco smoking was 22.2% (CI 21.0–23.5%), while the prevalence of illicit drug use was 11.8% (CI 10.9–12.7%). The predictors for smoking were the absence of alcohol-specific parental rule-setting, lower educational level, non-traditional family structure and positive drug screening. The predictors for illicit drug use were the absence of alcohol-specific parental rule-setting and smoking. Illicit drug use was also associated with a lower BAC at the time of admission.ConclusionsAssessing smoking and illicit drug use among adolescents admitted for acute alcohol intoxication is important in acute cases of intoxication, for outpatient follow-up and for the purposes of prevention. The relationship between simultaneous illicit drug use and a lower BAC is of relevance for paediatricians’ attempts to diagnose acute intoxication. With respect to outpatient follow-up and preventive measures, it is important to be aware that adolescents’ alcohol consumption, tobacco and illicit drug use are related and, ultimately, increase the odds of using other substances.

No family left behind: Flexibility i-deals for employees with stigmatized family identities

Most contemporary employers offer some policies to facilitate work–family (WF) balance for their employees. However, do the policies designed to help everyone suffice for unique employees with stigmatized social identities and non-traditional family structures? We conceptualize stigmatized family identity (SFI) to provide key insights on distinct WF issues experienced by such employees, and potential solutions in the form of person-specific work arrangements called idiosyncratic deals (i-deals). First, we define the construct of SFI, and exemplify its different types arising from the intersection of sexual orientation/gender identity/race and a non-traditional family structure. Second, we integrate literatures on WF and stigma to theorize the broad spectrum of WF issues and ensuing effects on job outcomes of employees with SFIs. Finally, we advance theory by developing a multi-level framework highlighting the importance of flexibility i-deals for employees with SFIs. Our framework identifies boundary conditions at individual, team, and organizational levels that can encourage (or deter) such employees from seeking i-deals. In doing so, we also explore the importance of privilege when it comes to SFI employees seeking i-deals.

Consideration of Social Disadvantages for Understanding and Preventing Obesity in Children.

Addressing social disadvantages that lead to obesity should be a public health priority. Obesity prevalence among children and adolescents has reached a plateau in countries with high income but it continues rising in low-income and middle-income countries. In high-income countries, an elevated prevalence of obesity is found among racial and ethnic minority groups and individuals from disadvantaged socioeconomic backgrounds. In addition to classic socioeconomic status (SES) factors, like income, parental education, and occupation, recent publications have linked parental social disadvantages, such as minimal social network, non-traditional family structure, migrant status and unemployment, with obesogenic behaviors and obesity among children. Socio-ecological models of obesity in children can explain the influence of classic SES factors, social disadvantages, culture, and genes on behaviors that could lead to obesity, contributing to the elevated prevalence of obesity. Obesity is a multifactorial disease in which multilevel interventions seem to be the most effective approach to prevent obesity in children, but previous meta-analyses have found that multilevel interventions had poor or inconsistent results. Despite these results, some multilevel interventions addressing specific disadvantaged social groups have shown beneficial effects on children's weight and energy balance-related behaviors, while other interventions have benefited children from both disadvantaged and non-disadvantaged backgrounds. Considering obesity as a worldwide problem, the World Health Organization, the European Commission, and the National Institutes of Health recommend the implementation of obesity prevention programs, but the implementation of such programs without taking into consideration social disadvantages may be an unsuccessful approach. Therefore, the present publication consists of a review of the pertinent literature related to social disadvantage and its consequences for behaviors that could lead to childhood obesity. In addition, we will discuss the relationship between social disadvantages and the socio-ecological model of obesity in children. Finally, we will summarize the relevant aspects of multilevel intervention programs aiming to prevent obesity in children and provide recommendations for future research and intervention approaches to improve weight status in children with social disadvantages.

Fertility Physicians’ Opinions and Attitudes on Access to Assisted Reproductive Technology: An Asia-Pacific Perspective

Background: Fertility physicians are gatekeepers of assisted reproductive technology (ART) and have immediate control over access to fertility care. However, little is understood about their attitudes and willingness to provide and support different procedures. Therefore, we examined fertility physicians’ perspectives on support of public funding and willingness to provide care in various scenarios. Methods: We invited fertility physicians attending the 8th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2018) to participate in a 10-minute survey. Participants completed the survey anonymously and in private. Results: 78 out of 105 fertility physicians from 12 countries completed the survey (response rate = 74.3%). Mean age was 44.9 years (SD = 11.1). A majority of respondents supported public funding for ART: 76.3% for intrauterine insemination and 80.5% for in vitro fertilization. For controversial procedures, a majority agreed to provide social egg freezing (88.5%) compared to sex selection (25.6%) and gene editing for nonmedical reasons (19.2%), p &lt; 0.001 for both comparisons. Support for public funding was also significantly higher for social egg freezing (51.3%) compared to sex selection (23.1%) and gene editing for nonmedical reasons (20.5%), p &lt; 0.001 for both comparisons. For eligibility criteria, willingness to provide treatment to single women (50.0%) was significantly higher compared to other nontraditional family structures — single men (33.3%), p &lt; 0.001, male homosexual couples (33.3%), p = 0.002, female homosexual couples (32.1%), p = 0.001 and unmarried heterosexual couples (32.1%), p = 0.004. Consistently, support for public finding was significantly higher for single women (32.1%) compared to single men (23.1%), p = 0.013, male homosexual couples (20.5%), p = 0.020, and unmarried heterosexual couples (20.5%), p = 0.006. Conclusions: These results show support for public funding and conservative opinions toward ART for nontraditional family structures among physicians in the Asia-Pacific region.

A cross-sectional study of obesogenic behaviours and family rules according to family structure in European children

BackgroundThere has been an increase in children growing up in non-traditional families, such as single-parent and blended families. Children from such families have a higher prevalence of obesity and poorer health outcomes, but research on the relationship with obesogenic behaviours is limited.ObjectivesTherefore, the aim of this study was to investigate whether there are associations between family structures and obesogenic behaviours and related family rules in European children and adolescents.MethodsThe sample included 7664 children (mean age ± SD: 10.9 ± 2.9) from 4923 families who were participants of the multi-centre I.Family study (2013/2014) conducted in 8 European countries. Family structure was assessed by a detailed interview on kinship and household. Obesogenic behaviours (screen time, sleep duration, consumption of sugar-sweetened beverages (SSBs)) and family rules (rules for computer and television, bedtime routine, availability of SSBs during meals) were determined by standardized questionnaires. Multilevel mixed-effects linear and logistic regression models were used to model the associations of family structure with obesogenic behaviours and family rules. Sex, age, parental education level, number of children and adults in the household and BMI z-score were covariates in the models. Two-parent biological families were set as the reference category.ResultsChildren from single-parent families were less likely to have family rules regarding screen time (OR: 0.62, 95% CI: 0.40–0.94, p = 0.026) with higher reported hours of screen time per week (β = 2.70 h/week, 95% CI: 1.39–4.00, p < 0.001). The frequency of weekly SSB consumption differed by family structure in a sex-specific manner: girls from single-parent (β = 3.19 frequency/week, 95% CI: 0.91–5.47, p = 0.006) and boys from blended/adoptive families (β = 3.01 frequency/week, 95% CI: 0.99–5.03, p = 0.004) consumed more SSBs. Sleep duration, bedtime routines and availability of SSBs during meals did not differ between children from these family structures. Parental education did not modify any of these associations.ConclusionsParents in non-traditional family structures appear to experience more difficulties in restricting screen time and the intake of SSBs in their children than parents in traditional two-parent family structures. Our findings therefore suggest that additional support and effective strategies for parents in non-traditional families may help to reduce obesogenic behaviours in children from such family types.

Debt types and burdens by family structures

PurposeThe purpose of this study was to examine family structure differences in debt types and burdens of American families.Design/methodology/approachData was from the 2016 Survey of Consumer Finances. Eight types of family structures, five specific debts, and two debt burden indicators are examined with multivariate logistic regressions.FindingsAfter controlling for several socioeconomic variables, multivariate logistic regression results show that married with children families are more likely than five other family types to have any debt. In terms of specific debt, married with children families are more likely than six other types of families to have mortgages, four other types to have credit card loans, five other types to have to vehicle loans, three other types to have education loans, and one other type to have purchase loans. Married with children families are more likely than three other types of families (childless married couples, single males, and single females) to be late in debt payment for 60 or more days.Research limitations/implicationsThe data is limited to one-year cross-sectional data. To gain more insights on this topic, panel data could be used.Practical implicationsThe findings can be used for financial service professionals to identify loan demand and risk associated with various family structures and develop effective marketing strategies to serve these clients.Social implicationsThe findings are informative for public policymakers to develop family friendly economic policies and for consumer educators who help consumers make effective financial decisions when borrowing various types of loans.Originality/valueFirst, this study uses an innovative definition of family structure that counts several nontraditional family structures. Second, this study examines family structure differences in holdings of five specific debts together.

Age at First Alcohol Use as a Possible Risk Factor for Adolescent Acute Alcohol Intoxication Hospital Admission in the Netherlands.

BackgroundThe primary objective of this study is to determine whether age at first alcohol use is a determinant for adolescent acute alcohol intoxication characteristics, such as age at first acute alcohol intoxication and blood alcohol concentration (BAC) at hospital admission. Around the world, as in the Netherlands, a key aim of alcohol policy is to postpone the age at first alcohol use. This is based on cohort studies that indicate a relationship between a younger age at first alcohol use and subsequent adult alcohol use disorders.MethodsThis study was conducted using a cohort of data comprising individuals under 18 years of age. Data were collected between 2007 and 2017 by the Dutch Pediatric Surveillance System (NSCK) in order to monitor trends in admissions for acute alcohol intoxication. Multivariate linear regression analyses were used to determine the association between age at first alcohol use and acute alcohol intoxication characteristics, such as age at first acute alcohol intoxication and BAC at admission.ResultsThis study indicates that among adolescents admitted for acute alcohol intoxication, adolescents who started drinking at ≤ 14 years of age are significantly more often female, lower educated, and raised in nontraditional family structures than adolescents who started drinking between 15 and 18 years of age. Multiple linear regression analyses indicated that age at first alcohol use, corrected for covariates, significantly predicted the age at acute alcohol intoxication and BAC at admission. The association between age at first alcohol use and age at intoxication was also found to be clinically relevant.ConclusionsAlthough causation cannot be implied based on the results of these analyses, the results of this study suggest that interventions delaying the age at first alcohol use could be successful in increasing the average age that adolescents are admitted to the hospital for acute alcohol intoxication.

“We’re Just Family, You Know?” Exploring the Discourses of Family in Gay Parents’ Relational Talk

ABSTRACTTo date, little is known about how gay male parents discursively create and sustain family identity and how they position themselves in relation to the dominant heteronormative discourses of the traditional family. Framed relational dialectics theory – this study explored the meaning(s) of family and fatherhood in married gay fathers’ relational talk. I interviewed 13 married gay parent dyads and conducted follow-up interviews to collect data across time as well as member check initial results. Using contrapuntal analysis, I identified the discourses of traditional family structure and nontraditional family structure at play. I argue that the couples’ talk reflected discursive struggles to generate relational meanings for their family identities.

Prospective associations between social vulnerabilities and children's weight status. Results from the IDEFICS study.

In high-income countries, childhood obesity follows a clear socioeconomic gradient with greater prevalence in children with lower socioeconomic status (SES). The extent to which the trend of other social vulnerabilities over time and the accumulation of these vulnerabilities can affect children's weight is still unknown. In the IDEFICS study, 8624 children aged 2.0-9.9 years from eight European countries were examined at baseline and after 2 years. Sociodemographic variables, maternal body mass index (BMI), and lifestyle were reported by parents. Children were measured and classified as thin, normal weight, and overweight/obese using the extended IOTF criteria. Four vulnerable groups were defined: children whose parents were migrants, children whose parents lack a social network, children from non-traditional families (children not living with both biological parents), and children with unemployed parents. Logistic mixed-effects models were used to study the association between vulnerabilities and children's weight at baseline and follow-up, temporal trends in vulnerabilities and children's weight and accumulation of vulnerabilities and children's weight. Models were adjusted for lifestyle, maternal BMI, parental education, and income. Children whose parents lost their social support at follow-up were more likely to be thin than non-vulnerable children (OR = 1.69, 99% CI = 1.03-2.78). Children whose parents had a migrant background (OR = 1.30, 99% CI 1.04-1.62), children from non-traditional families at both time points (OR = 1.40, 99% CI 1.03-1.90) and whose parents were unemployed at baseline and follow-up (OR = 2.03, 99% CI 1.03-3.99) were more likely to be overweight/obese compared to non-vulnerable children. Cross-sectionally, we did not find an association between parental lack of network, non-traditional family structure, or employment and children's weight status. Policy actions are required to tackle inadequate weight loss and gain among vulnerable children (especially those exposed over the long term) since they are at a higher risk of thinness and overweight.

Parenting Practices in Diverse Family Structures: Examination of Adolescents' Development and Adjustment.

This article explored the implications of diverse family structures on adolescents' adjustment, with an emphasis on whether and, if so, how diverse family structures influence and predict developmental outcomes. Family relationships within the family unit are a stronger predictor of adolescents' development than the particular family structure. Transitions in families that result in notable reductions in effective parenting practices and economic well-being will negatively affect youth, regardless of family structure. Family processes that promote optimal growth and development among youth in traditional two-parent, heterosexual households work similarly for those growing up in nontraditional family structures. A conceptual model to advance this field of research is offered, and implications for research and policy are discussed.

Predictors of Coordinated and Comprehensive Care Within a Medical Home for Children With Special Healthcare (CHSCN) Needs.

The purpose of this study was to examine predictors of coordinated and comprehensive care within a medical home among children with special health care needs (CSHCN). The latest version of the National Survey of Children with Special Health Care Needs (NS-CSHCN) employed a national random-digit-dial sample whereby US households were screened, resulting in 40,242 eligible respondents. Logistic regression analyses were performed modeling the probability of coordinated, comprehensive care in a medical home based on shared decision-making and other factors. A total of 29,845 cases were selected for inclusion in the model. Of these, 17,390 cases (58.3%) met the criteria for coordinated, comprehensive care in a medical home. Access to a community-based service systems had the greatest positive impact on coordinated, comprehensive care in a medical home. Adequate insurance coverage and being White/Caucasian were also positively associated with the dependent variable. Shared decision-making was reported by 72% of respondents and had a negative, but relatively negligible impact on coordinated, comprehensive care in a medical home. Increasing age, non-traditional family structures, urban residence, and public insurance were more influential, and negatively impacted the dependent variable. Providers and their respective organizations should seek to expand and improve health and support services at the community level.