Special Health Care Needs Research Articles

Lifecourse factors associated with flourishing among US children aged 1-5 years.

This study aimed to examine the association between lifecourse factors and flourishing among children ages 1-5 years. Using data from the combined 2016 and 2017 National Survey of Children's Health (N = 18 007 children aged 1-5 years), flourishing was defined as parent-reported child's affection, resilience, curiosity about learning, and affect. Multivariable logistic regression modelled the associations between lifecourse factors and flourishing. These factors were identified according to the lifecourse health development model. Approximately 63% of children aged 1-5 years were flourishing. Children who were female (vs. male, adjusted prevalence ratio [APR]: 1.06, 95% confidence interval [CI]: 1.00-1.11), White, non-Hispanic (vs. Black, non-Hispanic, APR: 1.13, 95% CI: 1.01-1.26), not having a special health care need (vs. special health care need, APR: 1.15, 95% CI: 1.03-1.26), not having an emotional, developmental or behavioural disorder (EBD) (vs. 1.66, 95% CI:1.23-2.10), spoke English at home (vs. other language, APR: 1.30, 95% CI: 1.06-1.54), parents received emotional social support (vs. no emotional social support, APR: 1.11, 95% CI: 1.01-1.21) and who lived in a supportive neighbourhood (vs. not in supportive neighbourhood, APR: 1.12, 95% CI:1.05-1.18) were more likely to flourish. Children from households within 0%-99% of the federal poverty level (APR: 0.89, 95% CI: 0.79-0.98) were less likely to be flourishing compared with their counterparts from households within 400% of the federal poverty level. Findings indicate that several lifecourse factors are associated with young children's flourishing, including being female, White, non-Hispanic, not having a special health care need or EBD, English as a primary language, parents receiving emotional social support, having neighbourhood support and a lower household income. Our findings promote the continuation of programmes supporting diverse and low-income children's families and communities such as home visiting and Head Start, which provide avenues for bolstering children's health and development across the lifespan.

The Impact of Having a Child With Special Healthcare Needs on Length of Military Service.

In 2010, the National Survey of Children with Special Healthcare Needs revealed that parents of children with special healthcare needs (CSHCN) report employment decisions are influenced by healthcare coverage needs. The U.S. military healthcare system arguably offers service member parents of CSHCN with the most comprehensive, inexpensive, long-term healthcare in the country-potentially increasing their incentive to remain in the military. This study explored the effect of having a CSHCN on the length of parental military service. A retrospective cohort was formed using the Military Health System database from 2008 to 2018. Included children were <10 years in 2010 and received ≥1 year of military healthcare between 2008 and 2010. The Pediatric Medical Complexity Algorithm categorized children as having special healthcare needs via ICD 9/10 codes as having complex chronic (C-CD), non-complex chronic (NC-CD), or no chronic disease (CD). Families were classified by the child with the most complex healthcare need. Duration of military healthcare eligibility measured parental length of service (LOS). ANOVA and linear regression analysis compared LOS by category. Logistic regression determined odds of parental LOS lasting the full 8-year study length. Adjusted analyses controlled for child age and sex, and military parent sex, rank, and marital status. Over 1.45 million children in 915,584 families were categorized as per the algorithm. Of individual children included, 292,050 (20.1%) were CSHCN including those with complex chronic and non-complex chronic conditions. After grouping by family, 80,909 (8.8%) families had a child/children with C-CD (mean LOS 6.39 years), 170,787 (18.7%) families had a child/children with NC-CD (mean LOS 6.41 years), and 663,888 (72.5%) families had children with no CD (mean LOS 5.7 years). In adjusted analysis, parents of children with C-CD and NC-CD served 0.4 [0.37-0.42] and 0.33 [0.31-0.34] years longer than parents of children with no CD; odds of parents serving for the full study period were increased 33% (1.33 [1.31-1.36]) in families of children with C-CD and 27% (1.27 [1.26-1.29]) in families of children with NC-CD. Findings indicate that military parents of CSHCN serve longer military careers than parents of children with no chronic conditions. Continued provision of free, high-quality healthcare coverage for dependent children may be important for service member retention. Retaining trained and experienced service members is key to ensuring a ready and lethal U.S. military.

Special health care needs during childhood and academic achievement in secondary school.

Secondary education has lifelong implications for wellbeing. We evaluated associations between the duration and timing of special health care needs (SHCN) across childhood and academic achievement in secondary school. Cohort design. The structured modelling approach was used to evaluate life-course models for associations between the duration and timing of SHCN (measured using a two-item SHCN screener across ages 4-5, 6-7, 8-9 and 10-11 years) and Grade 7 (median age 12.5 years) reading and numeracy achievement. Linear regressions were fitted for each life-course model: four critical period models (each including SHCN exposure in one period), one sensitive period model (including SHCN exposure in all periods) and two strict accumulation models (including the duration of SHCN exposure in linear form then categorical form). Interactions of SHCN with child sex and family socio-economic status (SES) were examined. Of 3734 children, 1845 were female. The number of children with SHCN was 434 (11.7%), 458 (12.9%), 534 (14.7%), 551 (15.4%) at 4-5, 6-7, 8-9 and 10-11 years respectively. For both outcomes, the linear strict accumulation model fitted best, and interactions of SHCN with sex and SES were non-significant. The average decrease in school achievement z score (95% confidence interval) per period of having SHCN was 0.04 (-0.07 to -0.02) for reading and 0.08 (-0.11 to -0.05) for numeracy. A longer duration of SHCN from age 4-11 years has small-sized cumulative associations with poorer Grade 7 reading and numeracy achievement. Each period of SHCN between 4 and 5 and 10-11 years was associated with nearly 0.05 and 0.1 of a standard deviation reduction in Grade 7 reading and numeracy scores respectively, and these associations did not appear to differ across sex or SES. These findings suggest that children with persistent SHCN are at risk of academic deficits and should receive focused interventions.

Awareness and Attitude of General and Specialist Dentists in Providing Oral Health-related Quality of Life for Children with Special Healthcare Needs.

ABSTRACTSpecial healthcare needs children (SHCNC) requires specialized knowledge acquired by additional training, as well as increased awareness and accommodative measures on part of general practitioners and specialist dentists beyond what is considered routine. Most dentists face challenges in treating these children, due to lack of awareness and insufficient training regarding the management of such children in a dental operatory.Aim and objectiveThis study was undertaken to investigate the awareness, practices, and hurdles faced by general dentists and dentists of various specialties in providing oral healthcare to children with special healthcare needs.Materials and methodsThe study was conducted in dental colleges and private dental clinics in and around Hyderabad. General dentists and dentists of various specialties were assessed through a structured questionnaire.Statistical analysisThe data obtained were analyzed with a Chi-square test (SPSS Version - 20).ResultsThe study showed that 80% of the dentists were willing to treat these children, but lack of sufficient training has been the major hurdle in the management of these children.ConclusionThe training of dentists in taking care of children with special healthcare needs should be enhanced to provide comprehensive dental care to these children, thereby enabling them to realize their normal level of functioning and lengthening their life span.How to cite this articleSuhasini K, Rajashekhar R, Reddy JS, et al. Awareness and Attitude of General and Specialist Dentists in Providing Oral Health-related Quality of Life for Children with Special Healthcare Needs. Int J Clin Pediatr Dent 2021;14(5):601–603.

Satisfaction of Oral Health Education among Parents and Caregivers Regarding Children with Special Healthcare Needs in Riyadh, Saudi Arabia

The aim of the study was to evaluate the satisfaction of an oral health promotion program among parents and caregivers of children with special healthcare needs (CSHCN) in Riyadh, Saudi Arabia. A digital survey using Google forms was used during an event to commemorate the World Disability Day. Stalls for oral health education and training were set up at Disabled Children Society, Riyadh, Saudi Arabia. Oral health education was carried out using written pamphlets, brochures, and videos. Live demonstration on dental models was used for tooth-brushing training using a powered toothbrush. Parents and caregivers were asked to complete a survey about oral health education during the event. An overall 189 parents and caregivers of CSHCN including 62 males and 127 females completed the survey. The responses were entered digitally prior to being evaluated. The respondents were parents and/or caregivers of children mostly having cerebral palsy followed by autism. Females consisted of 67% of the respondents. Eight-one percent of respondents rated it as highly satisfied. Ninety-one percent of the respondents perceived that the information provided was new for them regarding oral healthcare for CSHCN. Ninety-eight percent of respondents were likely to attend a similar event in the future. Majority of parents and caregivers of CSHCN were highly satisfied by the oral health education during the event. They felt that they can take better care of the oral health of their CSHCN after the oral health education and training. Oral health among CSHCN is neglected when compared to children among the general population. CSHCN exhibit many barriers to oral health care. Oral health promotion among CSHCN is important as they have a high unmet oral health need.

Dental Erosion Prevalence and Its Association With Obesity Among Children With and Without Special Healthcare Needs.

Dental erosion and childhood obesity are associated with a common risk factor, soft drink consumption. The present study aims to assess the prevalence of dental erosion and its association with obesity among children with and without special healthcare needs. A cross-sectional study was conducted on 1,200 school children (400 children with special needs (CSHN) and 800 children without special needs) in the age group of 6 to 16 years. Dental erosion was diagnosed according to World Health Organization (WHO) criteria. Body mass index (BMI; weight/height in kg/m2) was recorded for each child. The association of dental erosion and obesity was analysed using multivariate logistic regression analysis. A total of 331 (27.6%) children presented with dental erosion. Dental erosion prevalence among CSHN was 33.5% and among children without special needs was 24.6%. In the final fully adjusted model, children with obesity presented 2.32 times (95%CI 1.17-4.89, P = 0.001) higher odds ratio (OR) of having dental erosion than normal-weight children. Children who consumed soft drinks ≥ 1 time/day and 2-6 times a week presented with an OR of 2.65 (95%CI 1.23-5.21, P = 0.001) times of dental erosion. Children with chronic vomiting and bulimia presented with a 3.27 (95%CI 1.72-6.12, P = 0.001) times higher OR of dental erosion. Children with gastric reflux presented with a 3.21 (95%CI 1.52 - 5.86, P = 0.001) times higher OR of dental erosion. The prevalence of dental erosion was slightly higher for special needs children compared to children without special needs. The study outcome suggests that obesity, chronic vomiting, consumption of soft drinks, and gastric reflux are statistically significantly associated with dental erosion.

Translational Research – The Imperative for Care Coordination to Facilitate Healthcare Transition for Adolescents and Young Adults with Chronic Conditions and Special Healthcare Needs

Care coordination for adolescents and young adults with chronic conditions and/or special healthcare needs (SHCN) is essential to facilitate successful healthcare transitions (HCT) from pediatric to adult healthcare. Nursing care management and coordination focuses on the complexity of health conditions as children and adolescents with chronic conditions and/or SHCN and their family caregivers who have complex health literacy and social needs navigate multiple complex systems of care (Luther et al., 2019).

Oral Health-Related Quality-of-Life According to Dental Caries Severity, Body Mass Index and Sociodemographic Indicators in Children with Special Health Care Needs.

This study aimed to assess the impact of dental caries’ severity, body mass index (BMI), and sociodemographic factors on oral health-related quality of life (OHRQoL) for special health care needs (SHCN) children and the suitability of their caregivers as proxies to determine OHRQoL. This cross-sectional study recruited 107 pairs of SHCN children and their caregivers and asked them to complete a questionnaire on sociodemographic issues as well as the Arabic version of the early childhood oral health impact scale (A-ECOHIS). This was followed by a dental examination. Dental caries was measured using the dmft/DMFT index, while caries’ severity was also determined. The children’s height and weight were measured, and BMI (kg/m2) was recorded. Data were analyzed statistically using t-test, one-way ANOVA, and Poisson regression models. Our results revealed that the A-ECOHIS score was 10.93, while the OHRQoL was affected in 95.3% of children. The most-reported item was ‘pain in the teeth, mouth, or jaws’ (48.7%). By regression analysis, caries-free children (Odds Ratio (OR): 0.650) or those who had moderate caries (OR: 0.551) were less likely to have a negative impact on their OHRQoL than those with severe caries. Additionally, those whose caregivers had a maximum primary education (OR: 0.656) or whose occupation was in the health sector (OR: 0.721) were less likely to have a negative impact on their OHRQoL. Those who were ≤ 6 years old (OR: 1.188) were more likely to have a negative impact. BMI did not have a significant impact on the OHRQoL of the children. Further, we detected a significant positive correlation between children’s dmft/DMFT scores and the A-ECOHIS scores reported by the mothers. Given these variables, which included dental caries’ severity, but not BMI, and caregivers’ education level and occupation, plus the child’s age group, we found a significant impact on the OHRQoL. However, we found that mothers were better proxies for their children’s OHRQoL.

Unmet Needs of Male Caregivers of Children and Youth with Special Health Care Needs.

ObjectivesThe caregiving experiences and unique health needs of male caregivers of children and youth with special health care needs (CYSHCN) are not well described. This study seeks to understand potential unmet health needs and attitudes toward supportive resources from the perspective of a sample of male caregivers of CYSHCN.MethodsThis mixed-methods study recruited a convenience sample of 30 men with CYSHCN who receive care for a chronic medical condition from primary care medical homes in Pennsylvania. We conducted semi-structured interviews (SSI), administered quantitative surveys to caregivers, and produced a thematic analysis. The SSI explored the health needs of male caregivers, assessed attitudes toward and preferences regarding supportive resources, and garnered their advice to other caregivers regarding parenting and health care system navigation.ResultsParticipants’ median age is 41 years (IQR: 33, 44), and most (80%) reside full time with their CYSHCN. Most male caregivers deprioritized their own emotional, mental, and physical health needs to support the needs of their families. Many male caregivers articulated interest in seeking emotionally supportive resources (not time-intensive). They advised other male caregivers to remain involved in the medical care and wellbeing of their CYSCHN and to openly seek and receive emotional support despite the daily challenges they face.Conclusions for PracticeMale caregivers of CYSHCN experience intense daily stress and express the need for emotionally supportive resources. Programs designed to facilitate such support may benefit from flexible formats (time and location) and involve male caregivers of CYSHCN as both facilitators and participants.

Health Care Insurance Adequacy for Children and Youth With Special Health Care Needs.

US children and youth rely on insurance to access health care.1 Families living in or near poverty may qualify for public coverage with income thresholds for eligibility varying from 138% to 325% of the federal poverty level (FPL) across states.2 Other families may have commercial insurance through an employer or direct purchase.3 Families lacking insurance pay out-of-pocket for health care. The adequacy of insurance varies across insurance types,4 with some providing better coverage and access to care than others.5,6 Households with children and youth with special health care needs (CYSHCN) with low-to-middle income (ie, 200% to 399% of FPL) may be particularly sensitive to insurance variations, yet little is known about family perceptions of insurance adequacy.1,3 We compared these perceptions across insurance types for CYSHCN living in low-to-middle income families.We performed a retrospective analysis of 4321 responses of parents of CYSHCN aged 0 to 18 years in the 2016–2017 National Survey of Children’s Health, with family income that was 200% to 399% of FPL, representing 6 056 833 CYSHCN nationally. National Survey of Children’s Health uses the well-established and extensively used CYSCHN screener questions.7 CYSHCN with above-average use of health services, medications, and functional limitations were stratified as having greater health care needs.8 Family perceptions of benefits, coverage, referrals, and other health service aspects were compared across insurance types by using logistic regression, adjusting for age, race and ethnicity, and level of health care needs. For benefit adequacy, we included only families who reported the child had a specific need. The Boston Children’s Hospital Institutional Review Board waived review because the study did not meet criteria for human subjects research.Health insurance among CYSHCN in low-to-middle-income families included employer-sponsored (56%), public (22%), combination of public and commercial (9%), and direct-purchase commercial (3%); 6% had other types, including Tricare; 3% were uninsured; and 1% were missing. Thirteen percent of CYSHCN had greater health care needs. In general, family perceptions of insurance adequacy were highest for use of public insurance (Fig 1). The adjusted percentages of families perceiving that their child’s health insurance always offered benefits or covered services that met the child’s needs were 64% for public only, 56% for public-commercial combination, 51% for employer-sponsored, and 28% for direct purchase (P &lt; .001). The adjusted percentages of families perceiving that their child’s insurance always allowed him or her to see the health care providers that he or she needs were 74% for public only, 68% for public-commercial combination, 70% for employer-private, and 48% for direct purchase. Perceptions of insurance correlated with health care needs. For example, a big problem to get specialist care was reported more often by families of CYSHCN with greater versus lesser medical needs covered by direct purchase (23% vs 5%, P = .02).The current study reveals new findings about insurance adequacy for CYSHCN from low-to-middle-income families. Family-perceived adequacy of their children’s health insurance varied substantially. Some families may have had inaccurate knowledge of the exact coverage offered by their insurance. In general, public coverage was viewed as most adequate. Families of CYSHCN with greater health care needs reported more problems with their children’s insurance, especially with direct purchase. Affordable, direct-purchase plans may have offered less coverage of needed health services for CYSHCN. Public coverage may indeed have better benefits than commercial for CYSHCN. In 1965, when Medicare and Medicaid were established, Medicare lacked long-term care benefits, in part because of concerns that good long-term benefits would cost too much. Medicaid served more as a safety net for low-income people, including many elderly people who enrolled also in Medicaid, which had more comprehensive long-term benefits, and CYSHCN insured by Medicaid can also use these benefits. Early and periodic screening, diagnostic, and treatment benefits were added to ensure availability of health services and treatments for disabling conditions affecting growth and development.This study highlights the importance of public coverage for CYSHCN, especially children living near poverty. Future investigation is needed to assess (1) how many CYSHCN living near poverty and covered by commercial insurance, especially direct purchase, meet income eligibility for enrollment in their state’s public coverage program; (2) how commercial insurers could match public coverage benefits and services; and (3) approaches to improve the adequacy of all insurance types. These efforts will strengthen US health care coverage for CYSHCN and their health care needs.We acknowledge Matt Hall, PhD, and Adams Bellows, BS, for their contributions to this work.

Mothers view about oral health status, oral hygiene behaviors, and dental services utilization of their children with hearing impairment attending special schools.

Parents are the principal decision-makers regarding their child's health. Awareness of mothers' view about their children's health, particularly with special health care needs (SHCN) (include hearing impaired children), is essential for health care providers. Therefore, the present study aimed to assess the mothers view about oral health status, oral hygiene practices, and dental services utilization of their children with hearing impairment attending special schools. A cross-sectional study was conducted between May and September 2020 among mothers of students with hearing impairment attending special schools. Also, the telephone structured interview was used to gathering mothers view. 57.4% of the mothers rated their children's oral health status as excellent or good, 27.9% as moderate, and 14.7% as poor. About half of the mothers (49.2%) stated that their children used toothbrushes once daily, and 15% use dental floss. Also, 54% of the children visited the dentist before this survey's conduct. The findings of the present study suggest that children with hearing impairment can also have good oral health status and behaviors. These results may be attributed to the fact that the study sample was taken from two special schools. Also, only the mothers' perception assessment of students' oral health status was done. Further studies are required to increase the strength of evidence.

Alternative Conservative Approach for Tooth Build-Up in Patients with Special Healthcare Needs

Purpose: The success of an artificial crown mainly depends on the biomechanical factors such as bonding capacity of cement between the crown and abutment tooth, and root strength of the abutment tooth. In this case series, we aim to provide insight on the potential use of the cast metal post and cost for patients with intellectual disabilities and severely compromised tooth structure. Material and Methods: The first patient was a 41-year old male with the chief complaint of a dislodged porcelain fused metal (PFM) crown of tooth #20 (mandibular left second bicuspid). The patient was informed about the advantages, disadvantages, and risks of each option. After further consideration and discussion with the parents and the patient, we decided to rebuild the coronal tooth structure with the cast metal post and core and prosthetic restoration with the same crown. Patient satisfaction was measured on the visual analog scale as 10/10. The second case involves a 26-year old female, who presented with a chief complaint of chronic lingering pain on tooth #9. The tooth structure was extensively damaged and un-supportive of the ferrule, therefore, it was decided to build a metal post and core instead of a fiber post. The prosthetic restoration was made with a monolithic zirconia crown and the patient was followed up twice in 6 months and graded the satisfaction as 10/10 on a visual analog scale. Results: The most common type of posts used in dentistry has been cast post and cores in the last decade which generally includes an additional laboratory stage where a custom post is prepared according to the impression taken from the prepared post space. Conclusions: Both the presented cases explain an interesting advantage of restoring a root canal treated tooth with a metal post and core system which implies that in a prefabricated post and core restored tooth failure, a metal post, and core can potentially be the treatment of choice instead of extracting the tooth.

Mediated Relationships between Supplemental Nutrition Assistance Program Benefits, Food Hardships, Health Status, and Emergency Department Use Among Low‐Income Children with and without Special Health Care Needs

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.

Pediatric Complexity Tool Best Practice Alert: Early Identification of Care Coordination for Children with Special Health Care Needs.

Care coordination programs continue to be developed for children with special health care needs (CSHCN). The goals for these programs are to improve access, increase communication, and decrease the overall length of stay for CSHCN. Care coordination optimizes resources to support children's health and well-being early in their hospitalization and facilitates a smooth discharge process and transition to home. Providing care coordination for CSHCN requires collaboration from many disciplines. To achieve high-quality care coordination, early identification of medically complex pediatric patients on admission is optimal. For more efficient and timelier enrollment into our care coordination program, we created a best practice alert within our electronic medical record to help overcome the challenges in timely identification of CSHCN. The best practice alert has helped us to provide care coordination benefits to our patients earlier in their hospital course. The purpose of this paper is to describe a quality improvement initiative to improve the early identification of CSHCN on hospital admission through the development of a best practice alert.

Children With Special Health Care Needs and Forgone Family Employment.

Family income is known to affect child health, but this relationship can be bidirectional. We sought to characterize this relationship by quantifying forgone family employment (FFE) due to a child's health condition in families of children with special health care needs (CSHCN) with updated figures. We conducted a secondary data analysis from the 2016-2017 National Survey of Children's Health. CSHCN with previously employed caregivers were included (N = 14 050). FFE was defined as any family member having stopped work and/or reduced hours because of their child's health or health condition. Child, caregiver, and household characteristics were compared by FFE status. Logistic regression analysis was conducted to evaluate the association between hours of medical care provide by a family member and FFE. US Bureau of Labor Statistics reports were used to estimate lost earnings from FFE. FFE occurred in 14.5% (95% confidence interval [CI] 12.9%-16.1%) of previously employed families with CSHCN and was 40.9% (95% CI 27.1%-54.7%) for children with an intellectual disability. We observed disproportionately high FFE among CSHCN who were 0 to 5 years old and of Hispanic ethnicity. We found a strong association between FFE and increasing hours of family-provided medical care, with an adjusted odds ratio (aOR) of 1.72 (95% CI 1.25-2.36) for <1 hour per week (compared with 0 hours), an aOR of 5.96 (95% CI 4.30-8.27) for 1 to 4 hours per week, an aOR of 11.89 (95% CI 6.19-22.81) for 5 to 10 hours per week, and an aOR of 8.89 (95% CI 5.26-15.01) for >10 hours per week. Lost earnings for each household with FFE were estimated at ∼$18 000 per year. With our findings, we highlight the need to implement programs and policies that address forgone income experienced by families of CSHCN.

Are social stories beneficial for oral health promotion in preschool children with special healthcare needs?

Design A 24-month randomised, two-armed, double-blinded, parallel controlled trial.Methods Participants were recruited from educational centres for children with special healthcare needs (SHCN) aged 2-6 years. Out of the 37 special needs schools in Hong Kong, 19 were randomly selected, of which 16 met the inclusion criteria. Further exclusions occurred if the child was absent, no consent was signed or if they did not meet the inclusion criteria. All participants received standardised tooth brushing instructions. The test group were given validated social stories, while the control group utilised standard leaflets issued by the Department of Health. The resources were used both in education centre sessions in three phases and at home by parents. The oral health-related behaviours were assessed before and after interventions as well as dmft index. Caries was assessed via dmft at baseline and phase 3 (at 24 months). The severity of existing caries was assessed using the International Caries Detection and Assessment System. If existing carious lesions progressed from one stage to a more advanced stage, it was defined as progression. At baseline and each of the three follow-up visits, oral hygiene and gingival health were assessed using the modified gingival index and simplified debris index. Oral health behaviours assessed included tooth brushing performance (assessed by number of tooth brushing steps and duration/frequency), between-meal snacking (assessed by frequency) and dental visit experience (assessed as favourable if the child attended at least annual visits). It was then determined if these behaviours had improved. Data analysis utilised generalised estimating equations, negative binomial regression and binary logistic regression. Kappa statistics were used to test intra-examiner reliability on 10% of randomly selected participants.Results There was no significant difference in caries experience between the two groups after 24 months. The results suggest children in the test group displayed improved tooth brushing performance, better oral hygiene and more frequent dentist visits. Children from higher socioeconomic backgrounds also showed better oral hygiene compared to those from lower socioeconomic backgrounds.Conclusions Social stories may be useful resources to improve oral health-related behaviours in children with SHCN.

Preventive oral health care use for children with special health care needs aged 6 through 12 years enrolled in Medicaid: A mixed methods study

BackgroundThe authors aimed to assess preventive oral health care (POHC) use for children with special health care needs (CSHCN) aged 6 through 12 years enrolled in Medicaid and identify intervention strategies to improve oral health. MethodsIn this sequential mixed methods study, the authors analyzed 2012 Medicaid data for children aged 6 through 12 years in Washington state. They used eligibility and claims data to identify special health care needs status (independent variable) and POHC use (outcome variable). They ran modified Poisson regression models to generate prevalence rate ratios. They coded data from 21 key informant interviews deductively using content analytic techniques. ResultsOf the 208,648 children in the study, 18% were identified as CSHCN and 140,468 used POHC (67.3%). After adjusting for confounding variables, the authors found no difference in POHC use by special health care need status (prevalence rate ratio, 1.00; 95% CI, 0.99 to 1.01; P = .91). In the qualitative analysis, the authors identified 5 themes: caries risk depends on a child’s specific health condition, caries complicates overall health, having a special need creates a bigger barrier to care, legislation alone is “not going to make much of a dent,” and improvements across all fronts are needed to promote the oral health of CSHCN in Medicaid. ConclusionsCSHCN enrolled in Medicaid are just as likely as children without special health care needs to use POHC, although barriers to oral health care access persist for CSHCN. Practical ImplicationsFuture efforts should focus on comprehensive strategies that address the varying levels of dental disease risk and difficulties accessing oral health care within the diverse group of CSHCN.

Acceptance and Commitment Therapy for Children with Special Health Care Needs and Their Parents: A Systematic Review and Meta-Analysis.

Context: Acceptance and Commitment Therapy (ACT) is an emerging treatment for improving psychological well-being. Objective: To summarize research evaluating the effects of ACT on psychological well-being in children with special health care needs (SHCN) and their parents. Data Sources: An electronic literature search was conducted in PubMed, Web of Science, Ovid/EMBASE and PsycINFO (January 2000–April 2021). Study Selection: Included were studies that assessed ACT in children with SHCN (ages 0–17y) and/or parents of children with SHCN and had a comparator group. Data Extraction: Descriptive data were synthesized and presented in a tabular format, and data on relevant outcomes (e.g., depressive symptoms, stress, avoidance and fusion) were used in the meta-analyses to explore the effectiveness of ACT (administered independently with no other psychological therapy) compared to no treatment. Results: Ten studies were identified (child (7) and parent (3)). In children with SHCN, ACT was more effective than no treatment at helping depressive symptoms (standardized mean difference [SMD] = −4.27, 95% CI: −5.20, −3.34; p < 0.001) and avoidance and fusion (SMD = −1.64, 95% CI: −3.24, −0.03; p = 0.05), but not stress. In parents of children with SHCN, ACT may help psychological inflexibility (SMD = −0.77, 95% CI: −1.07, −0.47; p < 0.01). Limitations: There was considerable statistical heterogeneity in three of the six meta-analyses. Conclusions: There is some evidence that ACT may help with depressive symptoms in children with SHCN and psychological inflexibility in their parents. Research on the efficacy of ACT for a variety of children with SHCN and their parents is especially limited, and future research is needed.

Physical and Mental Health of Mothers and Fathers Caring for Children with Special Health Care Needs: The Influence of Community Resources

Research has demonstrated that caring for children with special health care needs (SHCN) affects parental health and well-being. The current study examines effects of community resources on physical and mental health of mothers and fathers caring for a child with SHCN. Analysis of the 2016 National Survey of Children’s Health found that fathers rated their physical and mental health higher than mothers. Greater neighborhood safety and fewer days missed school were significant community resources for both mothers’ and fathers’ physical and mental health. Health care resources were only significant predictors for mothers’ health but not for fathers’. The analysis found significant moderating relationships between days missed school and child symptomology and days missed school and maternal employment on mothers’ mental health. The importance of economic security and community resources for parental health when caring for a child with special health care needs is discussed, and practice and policy implications are developed.

Oral Health Among Children and Youth With Special Health Care Needs.

We sought to estimate the prevalence of oral health problems and receipt of preventive oral health (POH) services among children and youth with special health care needs (CYSHCN) and investigate associations with child- and family-level characteristics. We used pooled data from the 2016-2018 National Survey of Children's Health. The analytic sample was limited to children 1 to 17 years old, including 23 099 CYSHCN and 75 612 children without special health care needs (non-CYSHCN). Parent- and caregiver-reported measures of oral health problems were fair or poor teeth condition, decayed teeth and cavities, toothaches, and bleeding gums. POH services were preventive dental visits, cleanings, tooth brushing and oral health care instructions, fluoride, and sealants. Bivariate and multivariable logistic regression analyses were conducted. A higher proportion of CYSHCN than non-CYSHCN received a preventive dental visit in the past year (84% vs 78%, P < .0001). Similar patterns were found for the specific preventive services examined. However, CYSHCN had higher rates of oral health problems compared with non-CYSHCN. For example, decayed teeth and cavities were reported in 16% of CYSHCN versus 11% in non-CYSHCN (P < .0001). In adjusted analyses, several factors were significantly associated with decreased prevalence of receipt of POH services among CYSHCN, including younger or older age, lower household education, non-English language, lack of health insurance, lack of a medical home, and worse condition of teeth. CYSHCN have higher rates of POH service use yet worse oral health status than non-CYSHCN. Ensuring appropriate use of POH services among CYSHCN is critical to the reduction of oral health problems.